P-112 ALPHA-FETOPROTEIN AS A PROGNOSTIC FACTOR IN PATIENTS WITH HEPATOCELLULAR CARCINOMA SUBMITTED TO LIVER TRANSPLANTATION – BRAZILIAN MULTICENTER STUDY

Lopes Chagas, Aline; Alves de Mattos, Ângelo; Diniz, Márcio Augusto; Gonçalves Felga, Guilherme Eduardo; Santana Ferreira Boin, Ilka de Fátima; Martins Alves da Silva, Rita de Cássia; Ferreira da Silva, Renato; Parente Garcia, José Huygens; Soares Lima, Agnaldo; Uili Coelho, Júlio Cezar; Lisboa Bittencourt, Paulo; Avancini Ferreira Alves, Venâncio; Carneiro D'Albuquerque, Luiz Augusto; Carrilho, Flair José

doi:10.1016/j.aohep.2021.100472

ISSN: 1665-2681

Annals of Hepatology (AoH) is an international, open access journal published bi-monthly with funds from the Fundación Clínica Médica Sur. It is the official journal of the Mexican Association of Hepatology (AMH), the Latin American Association for the Study of the Liver (ALEH), the Canadian Association for the Study of the Liver (CASL) and the Czech Society of Hepatology (CSH). AoH publishes editorials, opinions, concise reviews, original articles, brief reports, letters to the editor, news from affiliated associations, clinical practice guidelines and summaries of congresses in the field of Hepatology.

Topics covered by AoH include alcoholic liver disease, autoimmune hepatitis, biliary diseases, drug-induced liver injury, genetic liver diseases, NAFLD/NASH and viral hepatitis (HAV, HBV, HCV, HDV, HEV). Our journal seeks to publish articles on basic clinical care and translational research focused on preventing rather than treating the complications of end-stage liver disease.

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Aline Lopes Chagas1,2, Ângelo Alves de Mattos3, Márcio Augusto Diniz4, Guilherme Eduardo Gonçalves Felga5, Ilka de Fátima Santana Ferreira Boin6, Rita de Cássia Martins Alves da Silva7, Renato Ferreira da Silva8, José Huygens Parente Garcia9, Agnaldo Soares Lima10, Júlio Cezar Uili Coelho11, Paulo Lisboa Bittencourt12, Venâncio Avancini Ferreira Alves2,13, Luiz Augusto Carneiro D'Albuquerque2,14, Flair José Carrilho1,2, Brazilian HCC Study Group

1 Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil

2 São Paulo Clinicas Liver Cancer Group, São Paulo, Brazil

3 Department of Gastroenterology, Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil

4 Biostatistics and Bioinformatics Research Center, Cedars Sinai Medical Center, Los Angeles, United States

5 Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil

6 Liver Transplantation Unit, State University of Campinas, Campinas, Brazil

7 Departamento de Clínica Médica e Unidade de Transplante de Fígado, Hospital de Base – Funfarme, Faculdade de Medicina de São José do Rio Preto – FAMERP, São José do Rio Preto, Brazil

8 Departamento de Cirugia e Unidade de Transplante de Fígado, Hospital de Base – FUNFARME, Faculdade de Medicina de São José do Rio Preto – FAMERP, São José do Rio Preto, Brazil

9 Ceará Unit of Liver Transplantation, Department of Surgery and Liver Transplantation, Federal University of Ceará, Fortaleza, Brazil

10 Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil

11 Federal University of Parana, Surgery Department, Curitiba, Brazil

12 Department of Gastroenterology and Hepatology, Portuguese Hospital of Salvador, Bahia, Brazil

13 Department of Pathology, University of São Paulo School of Medicine, São Paulo, Brazil

14 Digestive Organs Transplant Division, Hospital das Cínicas, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil

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Special issue

This article is part of special issue:

Vol. 24. Issue S1

Abstracts of the 2021 Annual meeting of the ALEH (Asociación Latinoamericana para el Estudio del Hígado)

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Background

Liver transplantation (LT) is the treatment of choice for unresectable early hepatocellular carcinoma (HCC). Previous studies demonstrated that Alpha-fetoprotein (AFP) is an important biomarker of prognosis and tumor recurrence.

Aims

The aim of our study was to analyze the role of AFP in the post-transplant outcomes of HCC patients undergoing LT.

Methods

We conducted a multicenter, retrospective cohort study, analyzing medical records of 1,119 liver transplant recipients with HCC in Brazil. Survival curves were presented using the Kaplan-Meier and compared using the log-rank test. Univariate cox regression analysis was fitted. We performed an evaluation of the effect of the continuous variable on the risk ratio, to define the best "cutoff point" of AFP level at HCC diagnosis and pre-transplantation capable of differentiating patients from risk of recurrence and survival.

Results

Among 1,119 cases, 81% of patients were male, with a mean age at transplantation of 58 years. At HCC diagnosis, 85% were within Milan Criteria (MC). Median pre-LT AFP was 9.7 ng/ml (0-40,800 ng/ml) and 51% of patients had pre-LT AFP ≤ 10 ng/ml. The overall survival was 63% in 5 years and post-LT HCC recurrence was observed in 8% of patients. We found AFP > 400ng/ml at HCC diagnosis and AFP pre-LT > 200ng/ml as the better “cutoff points” for both overall survival and recurrence risk. Patients with AFP pre-LT ≤ 200 ng/ml had a better overall survival and recurrence-free survival compared with patients with AFP > 200 ng/ml, respectively, 76% and 92% versus 67% and 66% in 5-years (p <0.001). Pre-LT AFP >200ng/ml and being outside MC at diagnosis were also independent risk factors for post-LT HCC recurrence and poor survival in multivariate analysis.

Conclusions

Our study demonstrated role of AFP as a main pre-transplant prognostic factor, both to predict post-LT tumor recurrence and survival.

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