title: Alpha-fetoprotein and modified response evaluation criteria in solid tumors progression after locoregional therapy as predictors of hepatocellular cancer recurrence and death after transplantation.
abstract: Locoregional therapy (LRT) is being increasingly used for the management of hepatocellular cancer (HCC) in patients listed for liver transplantation (LT). Although several selection criteria have been developed, stratifications of survival according to the pathology of explanted livers and pre-LT LRT are lacking. Radiological progression according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) and alpha-fetoprotein (AFP) behavior was reviewed for 306 patients within the Milan criteria (MC-IN) and 116 patients outside the Milan criteria (MC-OUT) who underwent LRT and LT between January 1999 and March 2010. A prospectively collected database originating from 6 collaborating European centers was used for the study. Sixty-one patients (14.5%) developed HCC recurrence. For both MC-IN and MC-OUT patients, an AFP slope > 15 ng/mL/month and mRECIST progression were unique independent risk factors for HCC recurrence and patient death. When the radiological Milan criteria (MC) status was combined with radiological and biological progression, MC-IN and MC-OUT patients without risk factors had similarly excellent 5-year tumor-free and patient survival rates. MC-IN patients with at least 1 risk factor had worse outcomes, and MC-OUT patients with at least 1 risk factor had the poorest survival (P < 0.001). In conclusion, both radiological and biological modifications permit documentation of the response to LRT in patients waiting for LT. According to these 2 parameters, tumor progression significantly increases the risk of recurrence and patient death not only for MC-OUT patients but also for MC-IN patients. The monitoring of both parameters in combination with the initial radiological MC status is an essential element for further refining the selection criteria for potential liver recipients with HCC.
authors.affiliation: Starzl Unit of Abdominal Transplantation, St. Luc University Hospital, Catholic University of Louvain, Brussels, Belgium; Department of General Surgery and Organ Transplantation, Umberto I Hospital, Sapienza University, Rome, Italy.
authors.forename: Quirino
authors.initials: Q
authors.lastname: Lai
authors.forename: Alfonso W
authors.initials: AW
authors.lastname: Avolio
authors.forename: Ivo
authors.initials: I
authors.lastname: Graziadei
authors.forename: Gerd
authors.initials: G
authors.lastname: Otto
authors.forename: Massimo
authors.initials: M
authors.lastname: Rossi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tisone
authors.forename: Pierre
authors.initials: P
authors.lastname: Goffette
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Vogel
authors.forename: Michael B
authors.initials: MB
authors.lastname: Pitton
authors.forename: Jan
authors.initials: J
authors.lastname: Lerut
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000401:mortality / Q000628:therapy; D016208:Databases, Factual; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D014850:Waiting Lists; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D007166:Immunosuppressive Agents; D000509:alpha-Fetoproteins