AFP ratio predicts HCC recurrence after liver transplantation.

BACKGROUND/AIMS

Hepatocellular carcinoma (HCC) is a leading indication for liver transplantation (LT) worldwide. Early identification of patients at risk for HCC recurrence is of paramount importance since early treatment of recurrent HCC after LT may be associated with increased survival. We evaluated incidence of and predictors for HCC recurrence, with a focus on the course of AFP levels.

METHODS

We performed a retrospective, single-center study of 99 HCC patients who underwent LT between January 28th, 1997 and May 11th, 2016. A multi-stage proportional hazards model with three stages was used to evaluate potential predictive markers, both by univariate and multivariable analysis, for influences on 1) recurrence after transplantation, 2) mortality without HCC recurrence, and 3) mortality after recurrence.

RESULTS

19/99 HCC patients showed recurrence after LT. Waiting time was not associated with overall HCC recurrence (HR = 1, p = 0.979). Similarly, waiting time did not affect mortality in LT recipients both with (HR = 0.97, p = 0.282) or without (HR = 0.99, p = 0.685) HCC recurrence. Log10-transformed AFP values at the time of LT (HR 1.75, p = 0.023) as well as after LT (HR 2.07, p = 0.037) were significantly associated with recurrence. Median survival in patients with a ratio (AFP at recurrence divided by AFP 3 months before recurrence) of 0.5 was greater than 70 months, as compared to a median of only 8 months in patients with a ratio of 5.

CONCLUSION

A rise in AFP levels rather than an absolute threshold could help to identify patients at short-term risk for HCC recurrence post LT, which may allow intensification of the surveillance strategy on an individualized basis.

Déclaration de conflit d'intérêts

I have read the journal's policy and the authors of this manuscript have the following competing interests: Christine Koch: Consultancies / speaker´s fees: Ipsen, Novartis, Servier, Eisai. Travel support: Medac, Ipsen Nina Weiler: Consultancies / speaker’s fees: Astellas, Novartis. Travel support: Astellas, Novartis, Abbvie. Johannes Vermehren: Consultancies/ speaker´s / fees: Abbott, AbbVie, Bristol-Myers Squibb, Gilead, Medtronic, Merck/MSD, Roche. Oliver Waidmann: Consultancies / speaker’s fees: Bayer, BMS, Celgene, Eisai, Ipsen, Merck, MSD, Novartis, Roche, Servier, Shire. Travel support: Abbvie, Bayer, Celgene, Gilead, Ipsen, Medac, Merck, Novartis. Funding: Medac, Novartis. Martin-Walter Welker: Consultancies / speaker’s fees: AbbVie, Amgen, Bayer, BMS, Gilead, Novartis, Roche. Travel support: AbbVie, Astellas, Bayer, BMS, Novartis, Janssen, Roche Andreas A. Schnitzbauer: advisory boards for Novartis and Chiesi Wolf Otto Bechstein: Advisory Boards Astellas, Novartis, Speaker fees: Astellas, Chiesi, Falk Foundation, Gore Deutschland, MCI Deutschland, medac GmbH, MerckSerono, SanofiAventis, SanofiGenzyme, Sirtex' This does not alter our adherence to PLOS One policies on sharing data and materials.