Serological Risk Index Based on Alpha-Fetoprotein and C-Reactive Protein to Indicate Futile Liver Transplantation Among Patients with Advanced Hepatocellular Carcinoma

摘要

BackgroundThe aim of this study was to establish a preoperatively available serological risk index using alpha-fetoprotein (AFP) and C-reactive protein (CRP) for predicting oncologically futile liver transplantation (LT) in hepatocellular carcinoma (HCC) patients.MethodsA total of 119 liver transplant patients with HCC were retrospectively analyzed. The prognostic impact of clinical and histopathologic factors including pre-LT serum AFP and CRP values was determined.ResultsApart from microvascular tumor invasion (MVI; odds ratio [OR] 15.77), pretransplant serum levels of AFP100ng/ml (OR 13.31) and CRP0.8mg/dl (OR 13.97) were identified as independent predictors of HCC recurrence. The cumulative risk of HCC relapse at 5years post-LT was 2.3% in low serological tumor activity (STA) index (AFP100ng/ml+CRP0.8mg/dl), 17.1% in intermediate STA (AFP100ng/ml or CRP0.8mg/dl), and 91.6% in high STA index (AFP100ng/ml+CRP0.8mg/dl; p0.001), respectively. High STA index was identified as most powerful pre-LT available predictor of MVI (OR 15.31) and posttransplant HCC recurrence (OR 54.44). Five-year recurrence-free survival rate in Milan Out patients with high STA was 0%, compared to 91.7% and 83.6% in those with low or intermediate STA index (p0.001), respectively.ConclusionOur proposed serological risk index based on pretransplant serum AFP and CRP values is able to predict oncologically futile LT among advanced HCC patients.