Impact of locoregional therapy and alpha-fetoprotein on outcomes in transplantation for liver cancer: A UNOS Region 6 pooled analysis

Linda L. Wong, Willscott (Scott) Naugler, Jonathan Schwartz, David Scott, Renuka Bhattacharya, Jorge Reyes, Susan Orloff

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Liver transplantation (LT) provides optimal long-term disease-free survival for hepatocellular carcinoma (HCC). High pre-LT alpha-fetoprotein (AFP) has been associated with HCC recurrence, but it is unclear whether a drop in AFP or locoregional therapy impacts survival/recurrence after LT. LT-recipients transplanted for HCC in three centers (UNOS Region 6) were reviewed (2006-2009) for demographics, tumor characteristics, locoregional therapy, AFP, recurrence, and survival. Among 211 LT recipients (mean age 56.4 yr, 83% male, mean MELD 12.2), 94% met Milan criteria and 61% received locoregional therapy. Mean disease-free survival (DFS) was 1549.7 d, and 84% are currently alive. Factors affecting DFS included recurrence (RR, 0.074; 95% CI, 0.038-0.14), normal peak AFP (29.6, 95% CI, 2.96-296.3), peak AFP >400 (RR, 0.15; 95% CI, 0.03-0.73) and AFP at LT >400 (RR, 15.5; 95% CI, 2.4-100.5). Twenty-one patients had recurrence and were more likely beyond Milan criteria (5/23(21%) vs. 8/220 (4%), p = 0.0038), with peak AFP >400 and AFP at LT >400 (p = 0.001). Locoregional therapy did not affect mean DFS (1458.0 vs. 1603.8 d, p = 0.05) or recurrence (12.5% vs. 6%). Predictors of recurrence were similar to previous studies, including high AFP and tumor outside Milan criteria. While locoregional therapy itself did not affect DFS/recurrence, a decrease in AFP pre-transplant appears to positively influence outcomes in those who received locoregional therapy.

Original languageEnglish (US)
JournalClinical Transplantation
Volume27
Issue number1
DOIs
StatePublished - Jan 2013

Fingerprint

alpha-Fetoproteins
Liver Neoplasms
Transplantation
Liver Transplantation
Recurrence
Disease-Free Survival
Therapeutics
Hepatocellular Carcinoma
Survival
Neoplasms
Demography
Transplants

Keywords

  • Alpha-fetoprotein
  • Chemoembolization
  • Hepatocellular cancer
  • Liver transplant
  • Locoregional therapy

ASJC Scopus subject areas

  • Transplantation

Cite this

Impact of locoregional therapy and alpha-fetoprotein on outcomes in transplantation for liver cancer : A UNOS Region 6 pooled analysis. / Wong, Linda L.; Naugler, Willscott (Scott); Schwartz, Jonathan; Scott, David; Bhattacharya, Renuka; Reyes, Jorge; Orloff, Susan.

In: Clinical Transplantation, Vol. 27, No. 1, 01.2013.

Research output: Contribution to journalArticle

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abstract = "Liver transplantation (LT) provides optimal long-term disease-free survival for hepatocellular carcinoma (HCC). High pre-LT alpha-fetoprotein (AFP) has been associated with HCC recurrence, but it is unclear whether a drop in AFP or locoregional therapy impacts survival/recurrence after LT. LT-recipients transplanted for HCC in three centers (UNOS Region 6) were reviewed (2006-2009) for demographics, tumor characteristics, locoregional therapy, AFP, recurrence, and survival. Among 211 LT recipients (mean age 56.4 yr, 83{\%} male, mean MELD 12.2), 94{\%} met Milan criteria and 61{\%} received locoregional therapy. Mean disease-free survival (DFS) was 1549.7 d, and 84{\%} are currently alive. Factors affecting DFS included recurrence (RR, 0.074; 95{\%} CI, 0.038-0.14), normal peak AFP (29.6, 95{\%} CI, 2.96-296.3), peak AFP >400 (RR, 0.15; 95{\%} CI, 0.03-0.73) and AFP at LT >400 (RR, 15.5; 95{\%} CI, 2.4-100.5). Twenty-one patients had recurrence and were more likely beyond Milan criteria (5/23(21{\%}) vs. 8/220 (4{\%}), p = 0.0038), with peak AFP >400 and AFP at LT >400 (p = 0.001). Locoregional therapy did not affect mean DFS (1458.0 vs. 1603.8 d, p = 0.05) or recurrence (12.5{\%} vs. 6{\%}). Predictors of recurrence were similar to previous studies, including high AFP and tumor outside Milan criteria. While locoregional therapy itself did not affect DFS/recurrence, a decrease in AFP pre-transplant appears to positively influence outcomes in those who received locoregional therapy.",
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AU - Scott, David

AU - Bhattacharya, Renuka

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