Magnitude of change in alpha-fetoprotein in response to transarterial chemoembolization predicts survival in patients undergoing liver transplantation for hepatocellular carcinoma

  • M. Bhat McGill University Health Centre
  • M. Hassanain McGill University Health Centre
  • E. Simoneau McGill University Health Centre
  • G. N. Tzimas McGill University Health Centre
  • P. Chaudhury McGill University Health Centre
  • M. Deschenes McGill University Health Centre
  • D. Valenti McGill University Health Centre
  • P. Ghali McGill University Health Centre
  • P. Wong McGill University Health Centre
  • T. Cabrera McGill University Health Centre
  • J. Barkun McGill University Health Centre
  • J.I. Tchervenkov McGill University Health Centre
  • P. Metrakos McGill University Hospital Center
Keywords: Hepatocellular carcinoma, transarterial chemoembolization, alpha-fetoprotein, liver transplantation

Abstract

Background

Downsizing strategies are often attempted for patients with hepatocellular carcinoma (hcc) before liver transplantation (lt). The objective of the present study was to determine clinical predictors of favourable survival outcomes after transarterial chemoembolization (tace) before lt for hcc outside the Milan criteria, so as to better select candidates for this strategy.

Methods

In this retrospective study, patients with hcc tumours either beyond Milan criteria (single lesion > 5 cm, 3 lesions with 1 or more > 3 cm) or at the upper limit of Milan criteria (single lesions between 4.1 cm and 5.0 cm), with a predicted waiting time of more than 3 months, received carboplatin-based tace treatments. Exclusion criteria for tace included Child–Pugh C cirrhosis or the presence of portal vein invasion or extrahepatic disease on imaging. Only patients without tumour progression after tace underwent lt.

Results

Of 160 hcc patients who received liver grafts between 1997 and 2010, 35 were treated with tace preoperatively. The median of the sum of tumour diameters was 6.7 cm (range: 4.8–8.5 cm), which decreased with tace to 5.0 cm (range: 3.3–7.0 cm) at transplantation (p < 0.0004). The percentage drop in alpha-fetoprotein (αfp) was a positive predictor (p = 0.0051) and the time from last tace treatment to transplantation was a negative predictor (p < 0.0001) for overall survival.

Conclusions

The percentage drop in αfp and a shorter time from the final tace treatment to transplantation significantly predicted improved overall survival after lt for hcc downsized with tace. As a serum marker, αfp should be followed when tace is used as a strategy to stabilize or downsize hcc lesions before lt.

Author Biographies

M. Bhat, McGill University Health Centre
Department of Medicine, Division of Gastroenterology
and Hepatology, Royal Victoria Hospital
M. Hassanain, McGill University Health Centre
Department of Surgery, Section of Transplantation,
Royal Victoria Hospital
E. Simoneau, McGill University Health Centre
Department of Surgery, Section of Transplantation,
Royal Victoria Hospital
G. N. Tzimas, McGill University Health Centre
Department of Surgery, Section of Transplantation,
Royal Victoria Hospital
P. Chaudhury, McGill University Health Centre
Department of Surgery, Section of Transplantation,
Royal Victoria Hospital
M. Deschenes, McGill University Health Centre
Department of Medicine, Division of Gastroenterology
and Hepatology, Royal Victoria Hospital
D. Valenti, McGill University Health Centre
Department of Radiology, Royal Victoria Hospital
P. Ghali, McGill University Health Centre
Department of Medicine, Division of Gastroenterology
and Hepatology, Royal Victoria Hospital
P. Wong, McGill University Health Centre
Department of Medicine, Division of Gastroenterology
and Hepatology, Royal Victoria Hospital
T. Cabrera, McGill University Health Centre
Department of Radiology, Royal Victoria Hospital
J. Barkun, McGill University Health Centre
Department of Surgery, Section of Transplantation,
Royal Victoria Hospital
J.I. Tchervenkov, McGill University Health Centre
Department of Surgery, Section of Transplantation,
Royal Victoria Hospital
P. Metrakos, McGill University Hospital Center

Director McGill University HPB Program

Director McGill University Transplant Program

Published
2013-07-04
How to Cite
Bhat, M., Hassanain, M., Simoneau, E., Tzimas, G. N., Chaudhury, P., Deschenes, M., Valenti, D., Ghali, P., Wong, P., Cabrera, T., Barkun, J., Tchervenkov, J., & Metrakos, P. (2013). Magnitude of change in alpha-fetoprotein in response to transarterial chemoembolization predicts survival in patients undergoing liver transplantation for hepatocellular carcinoma. Current Oncology, 20(5), 265-272. https://doi.org/10.3747/co.20.1270
Section
Surgical Oncology