title: Delta-slope of alpha-fetoprotein improves the ability to select liver transplant patients with hepatocellular cancer.
abstract: OBJECTIVE
  The aim of the present study was to investigate the role of different alpha-foetoprotein (AFP) determinations in order to propose a new model aimed at predicting intention-to-treat (ITT) death and post- liver transplantation (LT) recurrence in a cohort of patients with hepatocellular cancer (HCC) enlisted for LT.
  
  
  BACKGROUND
  Recent studies have increasingly focused on the role of AFP as a useful tool for patient selection in the setting of LT for HCC. However, no definitive AFP model has been definitively validated.
  
  
  METHODS
  A retrospective analysis was performed on 124 consecutive patients enlisted for LT in a UCL Brussels LT centre during the period January 2004 to March 2012. The median follow-up was 3.3 years (ranges: 1.7-6.3).
  
  
  RESULTS
  The area under the receiver-operating characteristic (AUROC) analysis showed the ability of the AFP delta-slope as a useful prognosticator of tumour-related drop-out and post-LT recurrence. In multivariate analyses, the delta-slope was an independent predictor of ITT death [hazard ratio (HR) = 1.014, P < 0.017] and post-LT tumour recurrence (HR = 1.020, P = 0.027). The 5-year ITT survival and disease-free survival rates were 66.0% versus 36.7% and 92.3% versus 53.8%, for patients meeting and exceeding the delta-slope cut-off value of 15 ng/ml/month, respectively.
  
  
  CONCLUSIONS
  Integration of the AFP delta-slope with conventional criteria may further improve patient selection and post-LT outcomes; prospective studies are needed to validate the present proposed model.
authors.affiliation: Starzl Unit of Abdominal Transplantation, University Hospitals St. Luc, Université Catholique Louvain UCL, Brussels, Belgium.|Department of General Surgery and Organ Transplantation, Umberto I Hospital, University Sapienza, Rome, Italy.
authors.forename: Quirino
authors.initials: Q
authors.lastname: Lai
authors.affiliation: Hospital Las Higueras Talcahuano, Universidad De Concepcion, Conception, Chile.
authors.forename: Milton
authors.initials: M
authors.lastname: Inostroza
authors.affiliation: Department of Hepatobiliary Surgery, Hospital Ibanaco, Cali, Colombia.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Rico Juri
authors.affiliation: Department of Imaging-Interventional Radiology, University Hospitals St. Luc, Université Catholique Louvain UCL, Brussels, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Goffette
authors.affiliation: Starzl Unit of Abdominal Transplantation, University Hospitals St. Luc, Université Catholique Louvain UCL, Brussels, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Lerut
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D003661:Decision Support Techniques; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: C097353:AFP protein, human; D000509:alpha-Fetoproteins