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Validation of the α-fetoprotein Model for Hepatocellular Carcinoma Recurrence After Transplantation in an Asian Population

Rhu, Jinsoo, MD1; Kim, Jong Man, MD, PhD1; Choi, Gyu Seong, MD, PhD1; Kwon, Choon Hyuck David, MD, PhD1; Joh, Jae-Won, MD1

doi: 10.1097/TP.0000000000002136
Original Clinical Science—Liver

Background This study was designed to validate the α-fetoprotein model for predicting recurrence after liver transplantation in Korean hepatocellular carcinoma patients.

Methods Patients who underwent liver transplantation for hepatocellular carcinoma at Samsung Medical Center between 2007 and 2015 were included. Recurrence, overall survival, and disease-specific survival of patients divided by both the Milan criteria and the α-fetoprotein model were compared using Kaplan-Meier log-rank test. The predictability of the α-fetoprotein model compared with the Milan criteria was tested by means of net reclassification improvement analysis applied to patients with a follow-up of at least 2 years.

Results A total of 400 patients were included in the study. Patients within Milan criteria had 5-year recurrence, and overall survival rates of 20.9% and 76.3%, respectively, compared with corresponding rates of 50.3% and 55.7%, respectively, for patients who were beyond Milan criteria. α-Fetoprotein model low-risk patients had 5-year recurrence and overall survival rates of 21.1% and 76.2%, respectively, compared with corresponding rates of 57.7% and 52.2%, respectively, in high-risk patients (P < 0.001, all). Although overall net reclassification improvements were statistically nonsignificant for recurrence (net reclassification improvements [NRI] = 1.7%, Z = 0.30, P = 0.7624), and overall survival (NRI = 9.0%, Z = 1.60, P = 0.1098), they were significantly better for predicting no recurrence (NRI = 6.6%, Z = 3.16, P = 0.0016) and no death. (NRI = 7.7%, Z = 3.65, P = 0.0003).

Conclusions The α-fetoprotein model seems to be a promising tool for liver transplantation candidacy, but further investigation is needed.

The investigators applied a prognostic model based on AFP to a Korean population of liver transplant candidates with HCC. Predictive power for recurrence is improved over Milan criteria alone.

1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Received 12 October 2017. Revision received 10 December 2017.

Accepted 2 January 2018.

Ther authors declare no funding or conflicts of interest.

J.R. participated in research design, writing of the article, and data analysis. J.M.K. participated in research design, writing of the article, and data analysis. G.S.C. participated in research design. C.H.D.K. participated in research design. J.W.J. participated in research design.

Correspondence: Jong Man Kim, MD, PhD, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. (yjongman21@gmail.com).

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.