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Current Oncology
Volume 20
Issue 5
10.3747/co.20.1270
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Current Oncology is published by MDPI from Volume 28 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Multimed Inc..
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Article

Magnitude of Change in Alpha-Fetoprotein in Response to Transarterial Chemoembolization Predicts Survival in Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma

by
M. Bhat
1,
M. Hassanain
2,3,
E. Simoneau
2,
G.N. Tzimas
2,4,
P. Chaudhury
2,
M. Deschenes
1,
D. Valenti
5,
P. Ghali
1,
P. Wong
1,
T. Cabrera
5,
J. Barkun
2,
J.I. Tchervenkov
2 and
P. Metrakos
2,3,*
1
Department of Medicine, Division of Gastroenterology and Hepatology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC H3A 1A1, Canada
2
Department of Surgery, Section of Transplantation, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC H3A 1A1, Canada
3
Department of Surgery, King Saud University, Riyadh, Saudi Arabia
4
Consultant Hepatobiliary Section, Hygeia Hospital, Athens, Greece
5
Department of Radiology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC H3A 1A1, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2013, 20(5), 265-272; https://doi.org/10.3747/co.20.1270
Submission received: 3 July 2013 / Revised: 6 August 2013 / Accepted: 8 September 2013 / Published: 1 October 2013

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.
Keywords: hepatocellular carcinoma; transarterial chemoembolization; alpha-fetoprotein; liver transplantation hepatocellular carcinoma; transarterial chemoembolization; alpha-fetoprotein; liver transplantation

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MDPI and ACS Style

Bhat, M.; Hassanain, M.; Simoneau, E.; Tzimas, G.N.; Chaudhury, P.; Deschenes, M.; Valenti, D.; Ghali, P.; Wong, P.; Cabrera, T.; et al. Magnitude of Change in Alpha-Fetoprotein in Response to Transarterial Chemoembolization Predicts Survival in Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma. Curr. Oncol. 2013, 20, 265-272. https://doi.org/10.3747/co.20.1270

AMA Style

Bhat M, Hassanain M, Simoneau E, Tzimas GN, Chaudhury P, Deschenes M, Valenti D, Ghali P, Wong P, Cabrera T, et al. Magnitude of Change in Alpha-Fetoprotein in Response to Transarterial Chemoembolization Predicts Survival in Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma. Current Oncology. 2013; 20(5):265-272. https://doi.org/10.3747/co.20.1270

Chicago/Turabian Style

Bhat, M., M. Hassanain, E. Simoneau, G.N. Tzimas, P. Chaudhury, M. Deschenes, D. Valenti, P. Ghali, P. Wong, T. Cabrera, and et al. 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, no. 5: 265-272. https://doi.org/10.3747/co.20.1270

APA Style

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. I., & 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

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