Three-dimensional tumor volume and serum alpha-fetoprotein are predictors of hepatocellular carcinoma recurrence after liver transplantation: refined selection criteria

2014 ◽  
Vol 28 (6) ◽  
pp. 728-736 ◽  
Author(s):  
Samy Kashkoush ◽  
Walid El Moghazy ◽  
Toshiyasu Kawahara ◽  
Boris Gala-Lopez ◽  
Christian Toso ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Selection Criteria ◽  
Tumor Volume ◽  
Three Dimensional ◽  
Alpha Fetoprotein ◽  
Serum Alpha Fetoprotein ◽  
Hepatocellular Carcinoma Recurrence

scholarly journals Liver Transplantation for Extended Criteria Hepatocellular Carcinoma Using Stable Response to Locoregional Therapy and Alpha-Fetoprotein as Selection Criteria

2020 ◽  
Vol 36 (6) ◽  
pp. 506-515
Author(s):  
Markus Bo Schoenberg ◽  
Hubertus Johann Wolfgang Anger ◽  
Julian Nikolaus Bucher ◽  
Gerald Denk ◽  
Enrico Narciso De Toni ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Selection Criteria ◽  
Validation Cohort ◽  
Alpha Fetoprotein ◽  
Long Term Results ◽  
Locoregional Therapy ◽  
Internal Validation ◽  
Dynamic Selection ◽  
Transplant Candidates

<b><i>Introduction:</i></b> Current practice to only prioritize hepatocellular carcinoma (HCC) that fulfill the Milan criteria (IN<sub>MC</sub>) is changing, since it causes the exclusion of patients who could benefit from liver transplantation. To select patients outside MC (OUT<sub>MC</sub>) for transplantation, we implemented extended selection criteria without up-front morphometric restrictions containing surrogate parameters of tumor biology. <b><i>Methods:</i></b> OUT<sub>MC</sub> patients were considered without restrictions of morphometrics and received locoregional treatment after interdisciplinary consultation. Our dynamic selection criteria for OUT<sub>MC</sub> patients required (IN<sub>MUC</sub>): (1) treatment response over (2) at least 6 months and (3) alpha-fetoprotein ≤400 ng/mL over the entire evaluation period. Patients with IN<sub>MC</sub> tumors served as control and internal validation cohort. <b><i>Results:</i></b> 31 of 170 liver transplant candidates were OUT<sub>MC</sub>. Of these, 8 dropped out. The remaining 23 patients met the selection criteria and underwent transplantation. Recurrence-free survival was higher in patients transplanted IN<sub>MC</sub> compared to those OUT<sub>MC</sub> IN<sub>MUC</sub> (92.2% vs. 70.8%; <i>p</i> = 0.026) after 5 years of follow-up. Overall survival showed no significant difference (<i>p</i> = 0.552). With dynamic selection of transplant candidates, recurrence could also be predicted for the IN<sub>MC</sub> patients as internal validation cohort (c-index: 0.896; CI 0.588–0.981, <i>p</i> = 0.005). <b><i>Conclusion:</i></b> Dynamic selection criteria for the stratification of patients with OUT<sub>MC</sub> HCCs is feasible and allows for excellent long-term results and acceptable tumor recurrence rates comparable to IN<sub>MC</sub> patients.

Extreme Elevation of Serum Alpha Fetoprotein in Decompensated Cirrhosis without Hcc: an Ominous Sign

2007 ◽  
Vol 22 (1) ◽  
pp. 19-23
Author(s):  
H. Senturk ◽  
R. Cumali
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Liver Failure ◽  
Alpha Fetoprotein ◽  
Decompensated Cirrhosis ◽  
Serum Alpha Fetoprotein

Three cases of extreme elevation of serum alpha fetoprotein (>10,000 ng/mL) with decompensated cirrhosis without demonstrable hepatocellular carcinoma are reported. While 2 patients died of liver failure, 1 survived after liver transplantation. Extreme elevation of alpha fetoprotein not associated with hepatocellular carcinoma in liver cirrhosis heralds an ominous prognosis necessitating urgent liver transplantation.

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