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Evaluation Of Patients With Hepatocellular Carcinomas That Do Not Produce Α-fetoprotein.

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Evaluation Of Patients With Hepatocellular Carcinomas That Do Not Produce Α-fetoprotein.

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Evaluation of Patients With Hepatocellular Carcinomas That Do Not Produce α-Fetoprotein.

Vatche G Agopian¹, Michael P Harlander-Locke², Daniela Markovic³

¹Dumont-UCLA (University of California, Los Angeles) Transplant Center and Liver Cancer Center, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles2Ronald Reagan UCLA Medical Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles.

|October 6, 2016

View abstract on PubMed

Summary

This summary is machine-generated.

Hepatocellular carcinoma (HCC) patients with non-alpha-fetoprotein-producing tumors (non-AFP-producing tumors) have better outcomes after liver transplant (LT) than those with AFP-producing tumors. Stratifying by AFP status may improve transplant candidate selection.

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Area of Science:

Hepatology
Transplant Surgery
Oncology

Background:

Serum alpha-fetoprotein (AFP) is a biomarker for hepatocellular carcinoma (HCC), indicating aggressive tumors and poorer outcomes post-liver transplant (LT).
Limited data exists on outcomes for HCC patients with tumors that do not produce AFP.

Purpose of the Study:

To compare characteristics and outcomes of LT recipients with AFP-producing HCC versus non-AFP-producing HCC.
To identify factors influencing recurrence in LT recipients with non-AFP-producing HCC.

Main Methods:

Retrospective analysis of 665 adult HCC patients undergoing LT from 1989-2013.
Categorization into AFP-producing (n=457) and non-AFP-producing (n=208) tumor groups based on pre-LT AFP levels (≤10 ng/mL).
Comparison of tumor characteristics, recurrence-free survival, and recurrence rates.

Main Results:

Non-AFP-producing tumors had more favorable pathology: fewer lesions, smaller cumulative diameter, less vascular invasion, and lower differentiation.
Non-AFP-producing tumors showed superior recurrence-free survival (88% at 1 year, 67% at 5 years) and lower 5-year recurrence rates (8.8%) compared to AFP-producing tumors (76% at 1 year, 51% at 5 years; 22% recurrence).
Within Milan criteria, non-AFP-producing tumors had 71% survival and 6% recurrence; outside criteria, AFP-producing tumors had 40% survival and 42% recurrence.

Conclusions:

Nearly one-third of HCC patients have non-AFP-producing tumors with better pathological features, lower recurrence, and superior survival post-LT.
Recurrence in non-AFP-producing HCC post-LT is predicted by radiologic and pathologic factors, but is negligible within Milan criteria.
Incorporating AFP status alongside radiological criteria can enhance selection and prioritization of LT candidates.