Dynamic α-Fetoprotein Response and Outcomes after Liver Tran
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According to a JAMA study, incorporation of a dynamic α-fetoprotein response into currently used morphometric hepatocellular carcinoma selection criteria appears to improve the ability to predict recurrence and may increase access to liver transplant for patients with hepatocellular carcinoma who would otherwise be denied potential cure.

The objective was to externally validate the New York/California (NYCA) score, a recently published multi-institutional US HCC selection tool that was the first model incorporating a dynamic α-fetoprotein response (AFP-R) and compare the validated score with currently accepted HCC selection tools, namely, the Milan Criteria (MC), the French-AFP (F-AFP), and Metroticket 2.0 models.

A retrospective, multicenter prognostic analysis of prospectively collected databases of 2236 adults undergoing liver transplant for HCC was conducted at 3 US, 1 Canadian, and 4 European centers. The AFP-R was measured as the difference between the maximum and final pre-liver transplant AFP level. Cox proportional hazards regression and competing risk regression analyses examined recurrence-free and overall survival. Receiver operating characteristic analyses and net reclassification index were used to compare NYCA with MC, F-AFP, and Metroticket 2.0.

Of 2236 patients, 1808 were men; the mean age was 58.3 years. A total of 545 patients did not meet the MC.

--The NYCA score proved valid on competing for risk regression analysis, accurately predicting recurrence-free and overall survival.

--The NYCA also predicted recurrence-free survival on a center-specific level: 453 of 545 patients who did not meet MC, 213 of 308 who did not meet the French-AFP, 292 of 384 who did not meet Metroticket 2.0 would be recategorized into NYCA low- and acceptable-risk groups.

--The Harrell C statistic for the validated NYCA score was 0.66 compared with 0.59 for the MC and 0.57 for the F-AFP models.

--The net reclassification index for NYCA was 8.1 vs MC, 12.9 vs F-AFP, and 10.1 vs Metroticket 2.0.

This study appears to externally validate the importance of AFP-R in the selection of patients with HCC for a liver transplant. The AFP-R represents one of the truly objective measures of biological characteristics available before transplantation. Incorporation of AFP-R into selection criteria allows safe expansion of MC and other models, offering liver transplant to patients with acceptable tumor biological characteristics who would otherwise be denied potential cure.

Source: https://jamanetwork.com/journals/jamasurgery/article-abstract/2779532