Clinicopathological Distinction of Low-AFP-Secreting vs. High-AFP-Secreting Hepatocellular Carcinomas

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Abstract

INTRODUCTION AND AIMS: We aimed to investigate the clinical and pathological differences between low-AFP-secreting (AFP < 20 ng/mL) and high-AFP-secreting (AFP ≥ 20 ng/mL) hepatocellular carcinomas in patients who undergo liver transplant (LT). MATERIAL AND METHODS: We evaluated 145 patients who underwent deceased donor LT for HCC from January 1, 2005 until August 1, 2015 at the Johns Hopkins Hospital. RESULTS: Median pre-LT AFP in the entire cohort was 13 ng/mL (IQR 6-59). Using serum AFP cutoff of 20 ng/mL, 61 (42%) patients had high-AFP-secreting tumors and 84 (58%) had low-AFP-secreting tumors. Patients with high -AFP-secreting tumors had larger lesions (3 cm vs. 2.4 cm, p = 0.024), and were more likely to have microvascular-invasion (36.1% vs. 20.2%, p = 0.02) and poor-differentiation (18% vs. 4.8%, p = 0.01), and tumor recurrence following LT (28% vs. 6%, p < 0.001). The 1-year, 3-year, and 5-year recurrence-free survival for patients in the low-AFP-secreting group compared to the high-AFP-secreting group were 100%, 92%, 92% vs. 81.3%, 71.3%, 68.5% respectively (p = 0.0003). CONCLUSION: AFP is a suboptimal predictor of tumor recurrence following liver transplant in HCC patients. However, it can have some value in distinguishing more aggressive forms of HCC (high-AFP-secreting) that are associated with higher tumor recurrence. Novel tumor biomarkers are needed that can enhance predicting tumor recurrence following LT based on tumor biology.

Original languageEnglish (US)
Pages (from-to)0-100
Number of pages101
JournalAnnals of Hepatology
Volume17
Issue number6
DOIs
StatePublished - Oct 16 2018

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Hepatocellular Carcinoma
Transplants
Liver
Neoplasms
Recurrence
Tumor Biomarkers
Tissue Donors
Survival
Serum

Keywords

  • AFP
  • Hepatocellular carcinoma
  • Liver transplantation
  • Milan criteria

ASJC Scopus subject areas

  • Hepatology

Cite this

@article{12cfb174ee3a403b9e3ba8474637db87,
title = "Clinicopathological Distinction of Low-AFP-Secreting vs. High-AFP-Secreting Hepatocellular Carcinomas",
abstract = "INTRODUCTION AND AIMS: We aimed to investigate the clinical and pathological differences between low-AFP-secreting (AFP < 20 ng/mL) and high-AFP-secreting (AFP ≥ 20 ng/mL) hepatocellular carcinomas in patients who undergo liver transplant (LT). MATERIAL AND METHODS: We evaluated 145 patients who underwent deceased donor LT for HCC from January 1, 2005 until August 1, 2015 at the Johns Hopkins Hospital. RESULTS: Median pre-LT AFP in the entire cohort was 13 ng/mL (IQR 6-59). Using serum AFP cutoff of 20 ng/mL, 61 (42{\%}) patients had high-AFP-secreting tumors and 84 (58{\%}) had low-AFP-secreting tumors. Patients with high -AFP-secreting tumors had larger lesions (3 cm vs. 2.4 cm, p = 0.024), and were more likely to have microvascular-invasion (36.1{\%} vs. 20.2{\%}, p = 0.02) and poor-differentiation (18{\%} vs. 4.8{\%}, p = 0.01), and tumor recurrence following LT (28{\%} vs. 6{\%}, p < 0.001). The 1-year, 3-year, and 5-year recurrence-free survival for patients in the low-AFP-secreting group compared to the high-AFP-secreting group were 100{\%}, 92{\%}, 92{\%} vs. 81.3{\%}, 71.3{\%}, 68.5{\%} respectively (p = 0.0003). CONCLUSION: AFP is a suboptimal predictor of tumor recurrence following liver transplant in HCC patients. However, it can have some value in distinguishing more aggressive forms of HCC (high-AFP-secreting) that are associated with higher tumor recurrence. Novel tumor biomarkers are needed that can enhance predicting tumor recurrence following LT based on tumor biology.",
keywords = "AFP, Hepatocellular carcinoma, Liver transplantation, Milan criteria",
author = "Ahmet Gurakar and Michelle Ma and Jacqueline Garonzik and Amy Kim and Anders, {Robert A} and Kiyoko Oshima and Georgiades, {Christos S} and Merve Gurakar and Shane Ottmann and Cameron, {Andrew M} and Benjamin Philosophe and Behnam Saberi",
year = "2018",
month = "10",
day = "16",
doi = "10.5604/01.3001.0012.7206",
language = "English (US)",
volume = "17",
pages = "0--100",
journal = "Annals of Hepatology",
issn = "1665-2681",
publisher = "Mexican Association of Hepatology",
number = "6",

}

TY - JOUR

T1 - Clinicopathological Distinction of Low-AFP-Secreting vs. High-AFP-Secreting Hepatocellular Carcinomas

AU - Gurakar, Ahmet

AU - Ma, Michelle

AU - Garonzik, Jacqueline

AU - Kim, Amy

AU - Anders, Robert A

AU - Oshima, Kiyoko

AU - Georgiades, Christos S

AU - Gurakar, Merve

AU - Ottmann, Shane

AU - Cameron, Andrew M

AU - Philosophe, Benjamin

AU - Saberi, Behnam

PY - 2018/10/16

Y1 - 2018/10/16

N2 - INTRODUCTION AND AIMS: We aimed to investigate the clinical and pathological differences between low-AFP-secreting (AFP < 20 ng/mL) and high-AFP-secreting (AFP ≥ 20 ng/mL) hepatocellular carcinomas in patients who undergo liver transplant (LT). MATERIAL AND METHODS: We evaluated 145 patients who underwent deceased donor LT for HCC from January 1, 2005 until August 1, 2015 at the Johns Hopkins Hospital. RESULTS: Median pre-LT AFP in the entire cohort was 13 ng/mL (IQR 6-59). Using serum AFP cutoff of 20 ng/mL, 61 (42%) patients had high-AFP-secreting tumors and 84 (58%) had low-AFP-secreting tumors. Patients with high -AFP-secreting tumors had larger lesions (3 cm vs. 2.4 cm, p = 0.024), and were more likely to have microvascular-invasion (36.1% vs. 20.2%, p = 0.02) and poor-differentiation (18% vs. 4.8%, p = 0.01), and tumor recurrence following LT (28% vs. 6%, p < 0.001). The 1-year, 3-year, and 5-year recurrence-free survival for patients in the low-AFP-secreting group compared to the high-AFP-secreting group were 100%, 92%, 92% vs. 81.3%, 71.3%, 68.5% respectively (p = 0.0003). CONCLUSION: AFP is a suboptimal predictor of tumor recurrence following liver transplant in HCC patients. However, it can have some value in distinguishing more aggressive forms of HCC (high-AFP-secreting) that are associated with higher tumor recurrence. Novel tumor biomarkers are needed that can enhance predicting tumor recurrence following LT based on tumor biology.

AB - INTRODUCTION AND AIMS: We aimed to investigate the clinical and pathological differences between low-AFP-secreting (AFP < 20 ng/mL) and high-AFP-secreting (AFP ≥ 20 ng/mL) hepatocellular carcinomas in patients who undergo liver transplant (LT). MATERIAL AND METHODS: We evaluated 145 patients who underwent deceased donor LT for HCC from January 1, 2005 until August 1, 2015 at the Johns Hopkins Hospital. RESULTS: Median pre-LT AFP in the entire cohort was 13 ng/mL (IQR 6-59). Using serum AFP cutoff of 20 ng/mL, 61 (42%) patients had high-AFP-secreting tumors and 84 (58%) had low-AFP-secreting tumors. Patients with high -AFP-secreting tumors had larger lesions (3 cm vs. 2.4 cm, p = 0.024), and were more likely to have microvascular-invasion (36.1% vs. 20.2%, p = 0.02) and poor-differentiation (18% vs. 4.8%, p = 0.01), and tumor recurrence following LT (28% vs. 6%, p < 0.001). The 1-year, 3-year, and 5-year recurrence-free survival for patients in the low-AFP-secreting group compared to the high-AFP-secreting group were 100%, 92%, 92% vs. 81.3%, 71.3%, 68.5% respectively (p = 0.0003). CONCLUSION: AFP is a suboptimal predictor of tumor recurrence following liver transplant in HCC patients. However, it can have some value in distinguishing more aggressive forms of HCC (high-AFP-secreting) that are associated with higher tumor recurrence. Novel tumor biomarkers are needed that can enhance predicting tumor recurrence following LT based on tumor biology.

KW - AFP

KW - Hepatocellular carcinoma

KW - Liver transplantation

KW - Milan criteria

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U2 - 10.5604/01.3001.0012.7206

DO - 10.5604/01.3001.0012.7206

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VL - 17

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JO - Annals of Hepatology

JF - Annals of Hepatology

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