title: Risk factors of hepatocellular carcinoma recurrence after liver transplantation: accuracy of the alpha-fetoprotein model in a single-center experience.
abstract: BACKGROUND
  Recurrence of hepatocellular carcinoma (HCC) and cirrhosis after a liver transplantation (LT) is a major concern, and a strict Milan criteria selection of candidates does not accurately discriminate the relapse rate after LT.
  
  
  OBJECTIVE
  This study sought to analyze the risk factors affecting tumor recurrence after LT for related cirrhosis HCC and the application of the French prognostic model (preLT alpha-fetoprotein [AFP], size, number) in a single center.
  
  
  METHODS
  In a retrospective observational study of LT for HCC and cirrhosis, clinicopathological features were analyzed. Also, the preoperative and postoperative AFP model score was calculated with a cutoff of 2.
  
  
  RESULTS
  Of 480, 109 patients underwent cadaveric LT for HCC. Eight of them had a relapse (7%). High AFP level, AFP model score >2, high pathological tumor-node-metastasis (pTNM) stage, poor differentiation, macrovascular-microvascular invasion, infiltration, and R1 margin were statistically significant (P < .05) for recurrence. Also, in the preoperative model, AFP score >2 was a predictor of worse survival (1-, 3-, 5-, 10-year survival of 81%, 51%, 30%, 30% vs 90%, 76%, 73%, 69% in ≤2, with P = .005). Regarding the postoperative model, similar results were found (1-, 3-, 5-, 10-year survival of 84%, 47%, 37%, 37% vs 90%, 78%, 73%, 52%, P = .028) between AFP model score >2 and ≤2, respectively. However, Milan and up-to-7 criteria were not accurate in recurrence nor in survival.
  
  
  CONCLUSIONS
  The French AFP model has proven to be a more discerning prognostic tool than other established criteria in the prediction of recurrence and survival. Also, in postoperative prognosis, pathological risk factors for relapse such as pTNM, differentiation grade, macrovascular-microvascular invasion, infiltration, and R1 margin have been predictors of recurrence.
authors: Department of Surgery, Hospital Universitario Nuestra Sra. De Candelaria, S/C de Tenerife, Spain. Electronic address: mvarbosa@gmail.com.
authors: M A
authors: MA
authors: Varona
authors: Department of Surgery, Hospital Universitario Nuestra Sra. De Candelaria, S/C de Tenerife, Spain.
authors: A
authors: A
authors: Soriano
authors: Investigation Unit, Hospital Universitario Nuestra Sra. De Candelaria, S/C de Tenerife, Spain.
authors: A
authors: A
authors: Aguirre-Jaime
authors: Department of Radiology/Hospital Universitario Nuestra Sra. De Candelaria, S/C de Tenerife, Spain.
authors: S
authors: S
authors: Garrido
authors: Department of Hepatology/Hospital Universitario Nuestra Sra. De Candelaria, S/C de Tenerife, Spain.
authors: E
authors: E
authors: Oton
authors: Department of Hepatology/Hospital Universitario Nuestra Sra. De Candelaria, S/C de Tenerife, Spain.
authors: D
authors: D
authors: Diaz
authors: Department of Vascular Radiology, Crta. El Rosario, no. 145, 38010, S/C de Tenerife, Spain.
authors: J
authors: J
authors: Portero
authors: Department of Anesthesiology/Hospital Universitario Nuestra Sra. De Candelaria, S/C de Tenerife, Spain.
authors: P
authors: P
authors: Bravo
authors: Department of Surgery, Hospital Universitario Nuestra Sra. De Candelaria, S/C de Tenerife, Spain.
authors: M A
authors: MA
authors: Barrera
authors: Department of Pathology/Hospital Universitario Nuestra Sra. De Candelaria, S/C de Tenerife, Spain.
authors: A
authors: A
authors: Perera
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology / Q000601:surgery*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery; D008113:Liver Neoplasms / Q000097:blood / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins