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

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Abstract

Background

The 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.

Methods

A 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.

Results

Apart from microvascular tumor invasion (MVI; odds ratio [OR] 15.77), pretransplant serum levels of AFP > 100 ng/ml (OR 13.31) and CRP > 0.8 mg/dl (OR 13.97) were identified as independent predictors of HCC recurrence. The cumulative risk of HCC relapse at 5 years post-LT was 2.3% in low serological tumor activity (STA) index (AFP ≤ 100 ng/ml + CRP ≤ 0.8 mg/dl), 17.1% in intermediate STA (AFP ≤ 100 ng/ml or CRP ≤ 0.8 mg/dl), and 91.6% in high STA index (AFP > 100 ng/ml + CRP > 0.8 mg/dl; p < 0.001), 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 (p < 0.001), respectively.

Conclusion

Our proposed serological risk index based on pretransplant serum AFP and CRP values is able to predict oncologically futile LT among advanced HCC patients.

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Abbreviations

AFP:

Alpha-fetoprotein

AUC:

Area under the curve

CI:

Confidence interval

CRP:

C-reactive protein

CT:

Computed tomography

HCC:

Hepatocellular carcinoma

IL:

Interleukin

LT:

Liver transplantation

LVI:

Lymphovascular invasion

MC:

Milan criteria

MELD:

Model of end-stage liver disease

MRI:

Magnetic resonance imaging

MVI:

Microvascular invasion

OR:

Odds ratio

OS:

Overall survival

RFS:

Recurrence-free survival

STA:

Serological tumor activity

TACE:

Transarterial chemotherapy

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Authors and Affiliations

  1. Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany

    Arno Kornberg, Martina Schernhammer & Helmut Friess

  2. Department of Anaesthesiology, Klinikum Großhadern, LMU Munich, Munich, Germany

    Jennifer Kornberg

  3. Institute of Pathology, Helios Klinikum Berlin, Berlin, Germany

    Katharina Thrum

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  1. Arno Kornberg
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Correspondence to Arno Kornberg.

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Kornberg, A., Schernhammer, M., Kornberg, J. et al. Serological Risk Index Based on Alpha-Fetoprotein and C-Reactive Protein to Indicate Futile Liver Transplantation Among Patients with Advanced Hepatocellular Carcinoma. Dig Dis Sci 64, 269–280 (2019). https://doi.org/10.1007/s10620-018-5296-9

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