Evaluation of absolute serum α-fetoprotein levels in liver transplant for hepatocellular cancer.
OBJECTIVE
An elevated serum α-fetoprotein (AFP) level before orthotopic liver transplant (OLT) is predictive of mortality after OLT for hepatocellular carcinoma (HCC).


METHODS
Retrospective analysis of a population-based cohort.


METHODS
United Network for Organ Sharing registry (2003-2008).


METHODS
We identified 2253 patients who underwent OLT for HCC with available pre-OLT serum AFP values.


METHODS
Patients were stratified by AFP levels into low (<20 ng/mL), medium (20-399 ng/mL), or high (≥400 ng/mL) groups. Clinical and pathological characteristics were compared among groups. Survival curves were constructed by the Kaplan-Meier method, and univariate and multivariate Cox-regression analysis was performed.


RESULTS
Of the 2253 patients, 1210 (53.7%), 805 (35.7%), and 238 (10.6%) were in the low, medium, and high AFP groups, respectively. On univariate analysis, the low AFP group demonstrated the best 4-year survival (76%) compared with the medium (65%; P = .001) and high (57%; P < .001) AFP groups. When AFP levels in patients with only stage II HCC underwent assessment, improved survival in the low AFP group was still observed (P < .001). On multivariate analysis, the medium and high AFP groups were associated with higher mortality (hazard ratios, 1.50 [95% confidence interval, 1.19-1.89; P = .001] and 2.11 [1.55-2.88; P < .001], respectively).


CONCLUSIONS
Serum AFP level is an independent prognostic predictor of outcome after OLT for HCC. The association between serum AFP value and post-OLT survival warrants further investigation to potentially better allocate donor allografts for HCC.
Department of Oncologic Surgery, City of Hope, Duarte, CA, USA.
Brian
B
Mailey
Avo
A
Artinyan
Joshua
J
Khalili
Jordan
J
Denitz
Nicelio
N
Sanchez-Luege
Can-Lan
CL
Sun
Smita
S
Bhatia
Nicholas
N
Nissen
Steven D
SD
Colquhoun
Joseph
J
Kim
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000032:analysis*
D000509:alpha-Fetoproteins