A revised scoring system utilizing serum alphafetoprotein levels to expand candidates for living donor transplantation in hepatocellular carcinoma

Background The development of living donor liver transplantation has stimulated discussion about the expansion of tumor burden limits for patients with hepatocellular carcinoma (HCC). Although serum alphafetoprotein (AFP) level is an important predictor of tumor recurrence, it is not included in the...

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Bibliographic Details
Published in:Surgery 2007-05, Vol.141 (5), p.598-609
Main Authors: Yang, Sung Hoon, MD, Suh, Kyung-Suk, MD, PhD, Lee, Hae Won, MD, Cho, Eung-Ho, MD, Cho, Jai Young, MD, Cho, Yong Beom, MD, Kim, In Hwan, MD, Yi, Nam-Joon, MD, PhD, Lee, Kuhn Uk, MD, PhD
Format: Article
Language:English
Subjects:
Adult
Aged
alpha-Fetoproteins - metabolism
Biological and medical sciences
Carcinoma, Hepatocellular - blood
Carcinoma, Hepatocellular - diagnosis
Carcinoma, Hepatocellular - surgery
Contraindications
Female
Gastroenterology. Liver. Pancreas. Abdomen
General aspects
Humans
Liver - pathology
Liver Neoplasms - blood
Liver Neoplasms - diagnosis
Liver Neoplasms - surgery
Liver Transplantation
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Living Donors
Male
Medical sciences
Middle Aged
Neoplasm Recurrence, Local - diagnosis
Neoplasm Staging
Prognosis
Retrospective Studies
Risk
Surgery
Survival Analysis
Tumors
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Summary:Background The development of living donor liver transplantation has stimulated discussion about the expansion of tumor burden limits for patients with hepatocellular carcinoma (HCC). Although serum alphafetoprotein (AFP) level is an important predictor of tumor recurrence, it is not included in the existing selection criteria for HCC in transplantation. Methods We performed a retrospective study of 63 consecutive adults with HCC diagnosed preoperatively who received living donor liver transplantation from February 1999 to September 2005 and survived over 1 month. The authors devised new scoring criteria that included tumor size, tumor number, and pretransplant AFP level as prognostic factors. The score of each parameter was classified from 1 to 4 points (tumor size, ≤3, 3.1 to 5, 5.1 to 6.5, >6.5 cm; tumor number, 1, 2 or 3, 4 or 5, or ≥6 nodules; and AFP, ≤20, 20.1 to 200, 200.1 to 1000, >1000 ng/mL, respectively). We defined that 3 to 6 points and 7 to 12 points were “transplantable” and “nontransplantable,” respectively. The usefulness of the devised criteria was then investigated as a method of selecting candidates with HCC for transplantation. Results The candidates’ overall 3-year survival rate and recurrence-free survival rate were 67% and 70% after transplantation, respectively. Based on pretransplant imaging, 37 (59%), 41 (65%), and 44 (70%) of the 63 patients met the Milan criteria, University of Californica, San Francisco (UCSF) criteria, and the new scoring criteria. Their 3-year survival rates were 80%, 78%, and 79%, respectively. Moreover, based on posttransplant data, the scoring criteria correlated with the risk of death and HCC recurrence (Milan criteria, P = .005 and .001; UCSF criteria, P = .013 and .001 for death and recurrence; scoring criteria, P < .001 for both). Conclusions The newly devised scoring criteria could expand usefully current selection criteria for transplantation without detrimentally affecting outcome in the living donor transplantation setting for HCC.
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2006.11.006