Preoperative alpha-fetoprotein slope is predictive of hepatocellular carcinoma recurrence after liver transplantation

Background: Liver transplantation (LT) offers a possible cure for patients with hepatocellular carcinoma (HCC) and cirrhosis. However, tumour progression while on the waiting list and tumour recurrence after LT are common. The prognostic significance of various pre- and postoperative variables were investigated in regard to tumour recurrence, with an emphasis on the slope of preoperative serum alpha-fetoprotein (AFP) levels. Patients and methods: Data from 48 patients who had HCC diagnosed preoperatively and underwent LT at the McGill University Health Centre (Montreal, Quebec) were reviewed retrospectively, and possible risk factors for tumour recurrence were examined. Results: Univariate analysis revealed a positive correlation between the preoperative AFP slope and vascular invasion (P=0.045), total tumour diameter at explant (P=0.040), Cancer of the Liver Italian Program score (P=0.017) and recurrence-free survival (P=0.028). Of the preoperative variables examined, only the preoperative AFP slope was identified as an independent predictor of tumour recurrence by multi-variate analysis. Receiver operating characteristic analysis showed that the best discriminant cut-off value, calculated as the value of the maximized likelihood ratio, was preoperative AFP slope greater than 50 μg/L per month. At this cut-off, sensitivity was 36%, and specificity was 97%. Patients with a preoperative AFP slope greater than 50 μg/L per month had a much worse one-year recurrence-free survival rate than those with a preoperative AFP slope 50 μg/L per month or less (40% versus 90%, P<0.001). Conclusions: These results suggest that the preoperative AFP slope is an important predictor of HCC recurrence after LT and should be examined in future studies of patients receiving LT for HCC.