title: Role of alpha-fetoprotein in selection of patients with hepatocellular carcinoma waiting for liver transplantation: must we reconsider it?
abstract: BACKGROUND
  Milan criteria (MC) represent the most commonly adopted criteria for the selection of patients with hepatocellular carcinoma (HCC) waiting for liver transplantation (LT). However, MC are exclusively based on morphological aspects. The aim of the present study was to evaluate pre-LT-detectable biological parameters, to compare them with morphological ones in terms of tumor recurrence prediction and patient survival.
  
  
  METHODS
  A cohort of 153 consecutive adult patients who underwent LT for HCC on cirrhosis from January 1999 to March 2009 was retrospectively analyzed.
  
  
  RESULTS
  HCC recurrence was observed in 12 patients (7.8%). At multivariate logistic regression analysis, serum alpha-fetoprotein (AFP) was the unique independent negative risk factor for the development of HCC recurrence (odds ratio 2.0, p=0.03). Adopting a cutoff value of 210 ng/mL, patients who presented serum AFP =210 ng/mL showed a 5-year survival rate of 23.3% versus 76.2% observed in patients with pre-LT serum AFP <210 ng/mL (log-rank test: <0.0001).
  
  
  CONCLUSIONS
  In our experience, AFP was the strongest predictor of HCC recurrence, stronger than tumor morphology. AFP could ameliorate the selection of LT candidates. Further studies to evaluate the combination of morphological and biological criteria are needed.
authors.affiliation: Department of General Surgery and Organ Transplantation, Sapienza University, Umberto I Hospital, Rome - Italy.
authors.forename: Quirino
authors.initials: Q
authors.lastname: Lai
authors.forename: Alfonso W
authors.initials: AW
authors.lastname: Avolio
authors.forename: Tommaso M
authors.initials: TM
authors.lastname: Manzia
authors.forename: Salvatore
authors.initials: S
authors.lastname: Agnes
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tisone
authors.forename: Pasquale B
authors.initials: PB
authors.lastname: Berloco
authors.forename: Massimo
authors.initials: M
authors.lastname: Rossi
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D000509:alpha-Fetoproteins