title: Prediction of hepatocellular carcinoma biological behavior in patient selection for liver transplantation.
abstract: Morphological criteria have always been considered the benchmark for selecting hepatocellular carcinoma (HCC) patients for liver transplantation (LT). These criteria, which are often inappropriate to express the tumor's biological behavior and aggressiveness, offer only a static view of the disease burden and are frequently unable to correctly stratify the tumor recurrence risk after LT. Alpha-fetoprotein (AFP) and its progression as well as AFP-mRNA, AFP-L3%, des-γ-carboxyprothrombin, inflammatory markers and other serological tests appear to be correlated with post-transplant outcomes. Several other markers for patient selection including functional imaging studies such as (18)F-FDG-PET imaging, histological evaluation of tumor grade, tissue-specific biomarkers, and molecular signatures have been outlined in the literature. HCC growth rate and response to pre-transplant therapies can further contribute to the transplant evaluation process of HCC patients. While AFP, its progression, and HCC response to pre-transplant therapy have already been used as a part of an integrated prognostic model for selecting patients, the utility of other markers in the transplant setting is still under investigation. This article intends to review the data in the literature concerning predictors that could be included in an integrated LT selection model and to evaluate the importance of biological aggressiveness in the evaluation process of these patients.
authors.affiliation: Umberto Cillo, Tommaso Giuliani, Marina Polacco, Luz Maria Herrero Manley, Alessandro Vitale, Hepatobiliary Surgery and Liver Transplantation Unit, Department of General Surgery and Organ Transplantation, University Hospital of Padua, 35128 Padova, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.affiliation: Umberto Cillo, Tommaso Giuliani, Marina Polacco, Luz Maria Herrero Manley, Alessandro Vitale, Hepatobiliary Surgery and Liver Transplantation Unit, Department of General Surgery and Organ Transplantation, University Hospital of Padua, 35128 Padova, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Giuliani
authors.affiliation: Umberto Cillo, Tommaso Giuliani, Marina Polacco, Luz Maria Herrero Manley, Alessandro Vitale, Hepatobiliary Surgery and Liver Transplantation Unit, Department of General Surgery and Organ Transplantation, University Hospital of Padua, 35128 Padova, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Polacco
authors.affiliation: Umberto Cillo, Tommaso Giuliani, Marina Polacco, Luz Maria Herrero Manley, Alessandro Vitale, Hepatobiliary Surgery and Liver Transplantation Unit, Department of General Surgery and Organ Transplantation, University Hospital of Padua, 35128 Padova, Italy.
authors.forename: Luz Maria
authors.initials: LM
authors.lastname: Herrero Manley
authors.affiliation: Umberto Cillo, Tommaso Giuliani, Marina Polacco, Luz Maria Herrero Manley, Alessandro Vitale, Hepatobiliary Surgery and Liver Transplantation Unit, Department of General Surgery and Organ Transplantation, University Hospital of Padua, 35128 Padova, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Crivellari
authors.affiliation: Umberto Cillo, Tommaso Giuliani, Marina Polacco, Luz Maria Herrero Manley, Alessandro Vitale, Hepatobiliary Surgery and Liver Transplantation Unit, Department of General Surgery and Organ Transplantation, University Hospital of Padua, 35128 Padova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vitale
mesh_terms: D015415:Biomarkers / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood / Q000235:genetics; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D016031:Liver Transplantation; D018579:Patient Selection; D049268:Positron-Emission Tomography; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood; D011516:Prothrombin; D012333:RNA, Messenger / Q000097:blood / Q000235:genetics; D000509:alpha-Fetoproteins / Q000235:genetics / Q000378:metabolism
chemical_list: C097353:AFP protein, human; D015415:Biomarkers; D014408:Biomarkers, Tumor; D011498:Protein Precursors; D012333:RNA, Messenger; D000509:alpha-Fetoproteins; D019788:Fluorodeoxyglucose F18; C008208:acarboxyprothrombin; D011516:Prothrombin
keywords: Biomarkers; Hepatocellular carcinoma; Histopathology; Integrated prognostic tool; Liver Alpha-fetoprotein; Recurrence; Transplantation