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Survival predictor in hepatocellular carcinoma patients with Hep B selected for liver transplants

a-Fetoprotein is a potential survival predictor in hepatocellular carcinoma patients with hepatitis B selected for liver transplantation, reports this month's issue of the European Journal of Gastroenterology & Hepatology.

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Risk factors can affect candidacy and prognosis following orthotopic liver transplantation with antiviral prophylaxis for the treatment of hepatocellular carcinoma (HCC) associated with hepatitis B virus (HBV) and cirrhosis.

Dr Qing Zhang and colleagues investigated the risk factors affecting orthotopic liver transplantation outcomes in patients with HCC/HBV-induced cirrhosis selected by 2 contemporary candidacy strategies.

From 2002 to 2006, 203 patients with HCC/HBV-cirrhosis undergoing orthotopic liver transplantation with antiviral prophylaxis were evaluated retrospectively.

Patients with uncomplicated HCC fulfilling Milan or Up-to-Seven but not Milan criteria were included.

The researchers reported that patients received postoperative immunosuppressive therapy.

Tumor-free survival and overall survival were assessed.

AFP of more than 200 ng/ml indicated poorer outcomes in all groups
European Journal of Gastroenterology & Hepatology

Univariate analyses between overall survival and clinical/demographic factors were carried out, including α-fetoprotein (AFP), aspartate aminotransferase, alanine aminotransferase, tumor size, tumor nodule number, vascular invasion, lymph node metastasis, and degree of differentiation.

The researchers compared overall survival was compared between the 3 groups on the basis of AFP level.

Conservative candidacy group overall survival and tumor-free survival were better than the inclusive candidacy group.

The team found that low AST, high tumor differentiation, and low AFP were significantly associated with improved overall survival in the inclusive candidacy group.

The researchers observed that low tumor nodule number and AFP levels were significantly associated with improved overall survival in the conservative candidacy group.

AFP of more than 200 ng/ml indicated poorer outcomes in all groups.

On further analysis, the researchers found that AFP was an independent predictor of overall survival.

Dr Zhang's team concludes, "Up-to-Seven criteria may be more appropriately stratified by AFP, AST, and tumor differentiation, and AFP is a potential independent survival predictor in HBV-associated HCC patients selected for orthotopic liver transplantation."

Eur J Gastroenterol Hepatol 2014: 26(5): 544-552
09 May 2014

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