title: Combination of morphologic criteria and α-fetoprotein in selection of patients with hepatocellular carcinoma for liver transplantation minimizes the problem of posttransplant tumor recurrence.
abstract: BACKGROUND
  Serum α-fetoprotein concentration (AFP) might be a useful addition to morphologic criteria for selecting patients with hepatocellular carcinoma (HCC) for liver transplantation (LT). The aim of this study was to evaluate the role of AFP in selecting HCC patients at minimal risk of posttransplant tumor recurrence in the setting of existing criteria.
  
  
  METHODS
  This retrospective cohort study was based on 121 HCC patients after LT performed at a single institution. AFP was evaluated as a predictor of posttransplant tumor recurrence with respect to fulfillment of the Milan, University of California, San Francisco (UCSF), and Up-to-7 criteria.
  
  
  RESULTS
  There was a nearly linear association between AFP and the risk of HCC recurrence (p < 0.001 for linear effect; p = 0.434 for nonlinear effect). AFP predicted HCC recurrence in patients (1) beyond the Milan criteria (p < 0.001; optimal cutoff 200 ng/ml); (2) within the UCSF criteria (p = 0.001; optimal cutoff 100 ng/ml) and beyond them (p = 0.015; optimal cutoff 200 ng/ml); and (3) within the Up-to-7 criteria (p = 0.001; optimal cutoff 100 ng/ml) and beyond them (p = 0.023; optimal cutoff 100 ng/ml) but not in patients within the Milan criteria (p = 0.834). Patients within either UCSF and Up-to-7 criteria with AFP level <100 ng/ml exhibited superior (100 %) 5-year recurrence-free survival-significantly higher than those within UCSF (p = 0.005) or Up-to-7 (p = 0.001) criteria with AFP levels higher than the estimated cutoffs or beyond with AFP levels less than the estimated cutoffs.
  
  
  CONCLUSIONS
  Combining the UCSF and Up-to-7 criteria with an AFP level <100 ng/ml is associated with minimal risk of tumor recurrence. Hence, this combination might be useful for selecting HCC patients for LT.
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097, Warsaw, Poland, michal.grat@gmail.com.
authors.forename: Michał
authors.initials: M
authors.lastname: Grąt
authors.forename: Oskar
authors.initials: O
authors.lastname: Kornasiewicz
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Lewandowski
authors.forename: Wacław
authors.initials: W
authors.lastname: Hołówko
authors.forename: Karolina
authors.initials: K
authors.lastname: Grąt
authors.forename: Konrad
authors.initials: K
authors.lastname: Kobryń
authors.forename: Waldemar
authors.initials: W
authors.lastname: Patkowski
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Zieniewicz
authors.forename: Marek
authors.initials: M
authors.lastname: Krawczyk
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D018579:Patient Selection; D012189:Retrospective Studies; D013997:Time Factors; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D000509:alpha-Fetoproteins