Delta-slope of alpha-fetoprotein improves the ability to select liver transplant patients with hepatocellular cancer

作者：Lai Quirino; Inostroza Milton; Juri Juan M Rico; Goffette Pierre; Lerut Jan^*

来源：Hepato Pancreato Biliary, 2015, 17(12): 1085-1095.

DOI：10.1111/hpb.12486

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.

• 出版日期2015-12