Dados do Trabalho

Título

Evaluation of the AFP model in patients with low risk recurrence profile: further evidence to support its inclusion for candidate’s selection.

Introdução

The presence of microvascular invasion (mvi) defines a group of patients with a “high-risk” of recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT). We aimed to evaluate and compare pre-LT risk assessment of the AFP model against Milan criteria in patients with a “low-risk profile” for HCC recurrence.

Material e Método

A multicenter multinational cohort study of consecutive adult patients from France, Italy and Latin America was included (2003-2011). Recipient characteristics, pre-transplant tumor characteristics and serum α-fetoprotein (AFP) levels were obtained at listing. Explanted liver findings included macroscopic and microscopic evaluation of each nodule, number and diameter (cm) of each, presence of mvi, and degree of tumor differentiation according to Edmonson-Steiner grading system (dedifferentiated tumors considered when a nuclear grade >II was observed in the specimen). Multivariate Cox regression models were conducted.

Resultados

Milan criteria and 94.8% had an AFP score ≤2 points. In “low rik profile” patients, MC was not associated with death [HR1.37(CI 0.83;3.90)] or HCC recurrence [HR 0.77 (CI 0.34;1.73)]; whereas the AFP model was associated with mortality [HR 0.25 (CI0.11;0.56)] and recurrence [HR 0.27 (CI 0.12;0.62)]. From a multivariable competing risk model, the AFP model was independently associated with HCC recurrence in patients with “low-risk” profile. In this sub-population, the AFP model but not Milan criteria was further associated with recurrence risk in a competing risk regression sensitivity analysis with a SHR of 0.26 (CI 0.09;0.68; P=0.006).

Discussão e Conclusões

Among patients with a low risk of HCC recurrence, our results showed further evidence to support the AFP model as
inclusion for candidate’s hyper-selection.

Palavras Chave

AFP, survival, HCC, liver transplantation,