title: Peri-Transplant Change in AFP Level: a Useful Predictor of Hepatocellular Carcinoma Recurrence Following Liver Transplantation.
abstract: Pretransplant alpha-fetoprotein (AFP) is a useful tumor marker predicting recurrence of hepatocellular carcinoma (HCC). Little is known, however, about the relationship between changes in AFP concentration and prognosis. This study investigated the clinical significance of change in peri-transplant AFP level as a predictor of HCC recurrence. Data from 125 HCC patients with elevated pretransplant AFP level who underwent liver transplantation (LT) between February 2000 and December 2010 were retrospectively reviewed. Patients with AFP normalization within 1 month after LT were classified into the rapid normalization group (n = 97), with all other patients classified into the non-rapid normalization group (n = 28). Tumor recurrence was observed in 17 of the 97 patients (17.5%) with rapid normalization; of these, 11 patients had high AFP levels and six had normal levels at recurrence. In contrast, tumor recurrence was observed in 24 of the 28 patients (85.7%) without rapid normalization, with all 24 having high AFP levels at recurrence. Multivariate analysis showed that non-rapid normalization (harzard ratio [HR], 4.41, P < 0.001), sex (HR, 3.26, P = 0.03), tumor size (HR, 1.15, P = 0.001), and microvascular invasion (HR, 2.65, P = 0.005) were independent risk factors for recurrence. In conclusion, rapid normalization of post-LT AFP level at 1 month is a useful clinical marker for HCC recurrence. Therefore, an adjuvant strategy and/or intensive screening are needed for patients who do not show rapid normalization.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.; Department of Surgery, Hallym University College of Medicine, Hwaseong, Korea.
authors.forename: Tae
authors.identifier: 0000-0003-3834-7125
authors.initials: T
authors.lastname: Yoo
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea .
authors.forename: Kwang-Woong
authors.identifier: 0000-0001-6412-1926
authors.initials: KW
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea .
authors.forename: Nam-Joon
authors.identifier: 0000-0002-5467-425X
authors.initials: NJ
authors.lastname: Yi
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea .
authors.forename: Young Rok
authors.identifier: 0000-0003-2408-7086
authors.initials: YR
authors.lastname: Choi
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea .
authors.forename: Hyeyoung
authors.identifier: 0000-0002-3157-8214
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea .
authors.forename: Suk-Won
authors.identifier: 0000-0001-6111-9601
authors.initials: SW
authors.lastname: Suh
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea .
authors.forename: Jae Hong
authors.identifier: 0000-0002-7749-039X
authors.initials: JH
authors.lastname: Jeong
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea .
authors.forename: Jeong-Moo
authors.identifier: 0000-0001-7806-8759
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea .
authors.forename: Kyung-Suk
authors.identifier: 0000-0002-9535-7349
authors.initials: KS
authors.lastname: Suh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins
keywords: Alpha-Fetoprotein; Hepatocellular Carcinoma; Liver Cancer; Liver Transplantation; Tumor Marker