title: Pretransplantation α-fetoprotein slope and milan criteria: strong predictors of hepatocellular carcinoma recurrence after transplantation.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is a major cause of orthotropic liver transplantations (OLT). However, tumor recurrence remains a concern. Our group has shown that a rising natural α-fetoprotein (AFP) slope (NAS) correlates with tumor characteristics. We want to assess if a rising NAS predicts tumor recurrence.
  
  
  METHODS
  We reviewed first OLT for HCC (n=144) at our center from 1992 to 2010. Patients with less than two AFP values before treatment were excluded (n=52). A rising NAS (>0.1 μg/L/day) was found in 28 patients whereas 64 presented a stable or dropping NAS. Demographics, pre-OLT therapy, and tumor characteristics were collected. Statistical analysis was performed using ANOVA, chi-square or Fisher's test, and logistic regression for recurrence after OLT.
  
  
  RESULTS
  Demographics were similar among the recurrence (n=12) and nonrecurrence (n=80) groups. Patients who recurred received more treatment (P=0.017), had a higher number of lesions (P=0.025), a greater total tumor size (P=0.001), and a higher incidence of microvascular invasion (P=0.013). More patients exceeded the Milan criteria (75.0% vs. 31.3%, odds ratio [OR] 6.60, 95% confidence interval [CI] 1.45-4.05, P=0.008) and had a rising NAS (58.3% vs. 26.3%, OR 3.20, 95% CI 1.11-9.22, P=0.024) among the recurrence group. NAS was also a strong predictor of microvascular invasion (P=0.040). After correcting for age and sex, both a rising NAS (OR 3.98, 95% CI 1.01-15.81, P=0.039) and nonadherence to Milan criteria (OR 5.69, 95% CI 1.14-28.38, P=0.034) were strong predictors of recurrence after OLT.
  
  
  CONCLUSIONS
  The NAS is a predictor of microvascular invasion, a finding exclusive to pathology and in itself a predictor of HCC recurrence after OLT. The NAS and Milan criteria are good predictors of recurrence. These results encourage a frequent monitoring of AFP variations before OLT.
authors.affiliation: McGill University Health Center Multi-Organ Transplant Program and Hepatopancreatobiliary Surgery, Royal Victoria Hospital, 687 Pine Avenue West, Room S10.26, Montreal, QC, Canada H3A 1A1.
authors.forename: Teodora C
authors.initials: TC
authors.lastname: Dumitra
authors.forename: Sinziana
authors.initials: S
authors.lastname: Dumitra
authors.forename: Peter P
authors.initials: PP
authors.lastname: Metrakos
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Barkun
authors.forename: Prosanto
authors.initials: P
authors.lastname: Chaudhury
authors.forename: Marc
authors.initials: M
authors.lastname: Deschênes
authors.forename: Steven
authors.initials: S
authors.lastname: Paraskevas
authors.forename: Mazen
authors.initials: M
authors.lastname: Hassanain
authors.forename: Jean I
authors.initials: JI
authors.lastname: Tchervenkov
mesh_terms: D000368:Aged; D015982:Bias; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000473:pathology / Q000601:surgery*; D005260:Female; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D000509:alpha-Fetoproteins