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α-Fetoprotein is a potential survival predictor in hepatocellular carcinoma patients with hepatitis B selected for liver transplantation

Zhang, Qinga,*; Shang, Leic,*; Zang, Yunjina,*; Chen, Xinguoa,*; Zhang, Lib,*; Wang, Yinga; Wang, Letiana; Liu, Yua; Mao, Shaa; Shen, Zhongyanga

European Journal of Gastroenterology & Hepatology: May 2014 - Volume 26 - Issue 5 - p 544–552
doi: 10.1097/MEG.0000000000000029
Original Articles: Hepatocellular Carcinoma

Background Risk factors can affect candidacy and prognosis following orthotopic liver transplantation (OLT) with antiviral prophylaxis for the treatment of hepatocellular carcinoma (HCC) associated with hepatitis B virus (HBV) and cirrhosis.

Objective The objective of this study was to investigate the risk factors affecting OLT outcomes in patients with HCC/HBV-induced cirrhosis selected by two contemporary candidacy strategies.

Patients and methods From July 2002 to December 2006, 203 patients with HCC/HBV-cirrhosis undergoing OLT with antiviral prophylaxis were evaluated retrospectively. Patients with uncomplicated HCC fulfilling Milan (conservative candidacy group) or Up-to-Seven but not Milan (inclusive candidacy group) criteria were included. Patients received postoperative immunosuppressive therapy. Tumor-free survival and overall survival (OS) were assessed. Univariate analyses between OS and clinical/demographic factors were carried out, including α-fetoprotein (AFP), aspartate aminotransferase, alanine aminotransferase, tumor size, tumor nodule number, vascular invasion, lymph node metastasis, and degree of differentiation. OS was compared between the three groups on the basis of AFP level (≤20, 20–200, and >200 ng/ml).

Results Conservative candidacy group OS and tumor-free survival were better than the inclusive candidacy group. Low AST, high tumor differentiation, and low AFP were significantly associated with improved OS in the inclusive candidacy group (P<0.05). Low tumor nodule number and AFP levels were significantly associated with improved OS in the conservative candidacy group (P<0.05). AFP of more than 200 ng/ml indicated poorer outcomes in all groups. In multivariate analysis, AFP was an independent predictor of OS.

Conclusion Up-to-Seven criteria may be more appropriately stratified by AFP, AST, and tumor differentiation, and AFP is a potential independent survival predictor in HBV-associated HCC patients selected for OLT.

aThe Institute of Organ Transplantation, General Hospital of Chinese People’s Armed Police Force, Beijing

bFirst Department of Surgery, Shanxi Provincial Corps Hospital of Chinese People’s Armed Police Force

cDepartment of Health Statistics, Faculty of Preventive Medicine, Fourth Military Medical University, Xi’an, China

* Qing Zhang, Lei Shang, Yunjin Zang, Xinguo Chen, and Li Zhang contributed equally for the writing of this article.

All supplementary digital content is available directly from the corresponding author.

Correspondence to Zhongyang Shen, PhD, The Institute of Organ Transplantation, General Hospital of Chinese People’s Armed Police Force, 69 Yongding Road, Haidian District, Beijing 100039, China Tel: +86 10 57976839; fax: +86 10 68242910; e-mail:

Received July 31, 2013

Accepted November 26, 2013

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins