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Alpha‐fetoprotein and modified response evaluation criteria in Solid Tumors progression after locoregional therapy as predictors of hepatocellular cancer recurrence and death after transplantation
Author(s) -
Lai Quirino,
Avolio Alfonso W.,
Graziadei Ivo,
Otto Gerd,
Rossi Massimo,
Tisone Giuseppe,
Goffette Pierre,
Vogel Wolfgang,
Pitton Michael B.,
Lerut Jan
Publication year - 2013
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.23706
Subject(s) - medicine , liver transplantation , milan criteria , hepatocellular carcinoma , radiological weapon , response evaluation criteria in solid tumors , transplantation , cancer , liver cancer , oncology , tumor progression , hepatocellular cancer , surgery , chemotherapy , progressive disease
Locoregional therapy (LRT) is being increasingly used for the management of hepatocellular cancer (HCC) in patients listed for liver transplantation (LT). Although several selection criteria have been developed, stratifications of survival according to the pathology of explanted livers and pre‐LT LRT are lacking. Radiological progression according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) and alpha‐fetoprotein (AFP) behavior was reviewed for 306 patients within the Milan criteria (MC‐IN) and 116 patients outside the Milan criteria (MC‐OUT) who underwent LRT and LT between January 1999 and March 2010. A prospectively collected database originating from 6 collaborating European centers was used for the study. Sixty‐one patients (14.5%) developed HCC recurrence. For both MC‐IN and MC‐OUT patients, an AFP slope > 15 ng/mL/month and mRECIST progression were unique independent risk factors for HCC recurrence and patient death. When the radiological Milan criteria (MC) status was combined with radiological and biological progression, MC‐IN and MC‐OUT patients without risk factors had similarly excellent 5‐year tumor‐free and patient survival rates. MC‐IN patients with at least 1 risk factor had worse outcomes, and MC‐OUT patients with at least 1 risk factor had the poorest survival ( P < 0.001). In conclusion, both radiological and biological modifications permit documentation of the response to LRT in patients waiting for LT. According to these 2 parameters, tumor progression significantly increases the risk of recurrence and patient death not only for MC‐OUT patients but also for MC‐IN patients. The monitoring of both parameters in combination with the initial radiological MC status is an essential element for further refining the selection criteria for potential liver recipients with HCC. Liver Transpl 19:1108‐1118, 2013 . © 2013 AASLD.