Alpha-fetoprotein and 18F-FDG positron emission tomography predict tumor recurrence better than Milan criteria in living donor liver transplantation

Given the organ shortage for liver transplantation (LT) and the limitations of the current morphology-based selection criteria, improved criteria are needed to achieve the maximum benefit of LT for hepatocellular carcinoma (HCC). We hypothesized that a combination of biological markers may better pr...

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Published in:Journal of hepatology 2016-04, Vol.64 (4), p.852-859
Main Authors: Hong, Geun, Suh, Kyung-Suk, Suh, Suk-won, Yoo, Tae, Kim, Hyeyoung, Park, Min-Su, Choi, YoungRok, Paeng, Jin Chul, Yi, Nam-Joon, Lee, Kwang-Woong
Format: Article
Language:English
Subjects:
Alpha-fetoproteins
Biological factors
Fluorodeoxyglucose F18
Hepatocellular carcinoma
Liver transplantation
Living donors
Positron emission tomography
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Summary:Given the organ shortage for liver transplantation (LT) and the limitations of the current morphology-based selection criteria, improved criteria are needed to achieve the maximum benefit of LT for hepatocellular carcinoma (HCC). We hypothesized that a combination of biological markers may better predict the prognosis than the Milan criteria. HCC patients (n=123) with preoperative data on serum alpha-fetoprotein (AFP) levels and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) positivity underwent live-donor LT between January 2003 and December 2009. The cut-off values for serum AFP levels (200ng/ml) and 18F-FDG PET positivity (1.10) for tumor recurrence were determined by c-statistics using receiver operating characteristic curves. Univariate and multivariate analyses with preoperative variables were performed to find pre-transplant prognostic factors. Disease-free survival rates and overall survival rates were analysed with regard to serum AFP levels and 18F-FDG PET positivity. The 5-year disease-free survival rates and overall survival rates were 80.3% and 81.6% respectively. 18F-FDG PET positivity (hazard ratio (HR) 9.766, 95% CI 3.557–26.816; p
ISSN:0168-8278
1600-0641
DOI:10.1016/j.jhep.2015.11.033