α-Fetoprotein is a potential survival predictor in hepatocellular carcinoma patients with hepatitis B selected for liver transplantation

BACKGROUNDRisk factors can affect candidacy and prognosis following orthotopic liver transplantation (OLT) with antiviral prophylaxis for the treatment of hepatocellular carcinoma (HCC) associated with hepatitis B virus (HBV) and cirrhosis. OBJECTIVEThe objective of this study was to investigate the risk factors affecting OLT outcomes in patients with HCC/HBV-induced cirrhosis selected by two contemporary candidacy strategies. PATIENTS AND METHODSFrom July 2002 to December 2006, 203 patients with HCC/HBV-cirrhosis undergoing OLT with antiviral prophylaxis were evaluated retrospectively. Patients with uncomplicated HCC fulfilling Milan (conservative candidacy group) or Up-to-Seven but not Milan (inclusive candidacy group) criteria were included. Patients received postoperative immunosuppressive therapy. Tumor-free survival and overall survival (OS) were assessed. Univariate analyses between OS and clinical/demographic factors were carried out, including α-fetoprotein (AFP), aspartate aminotransferase, alanine aminotransferase, tumor size, tumor nodule number, vascular invasion, lymph node metastasis, and degree of differentiation. OS was compared between the three groups on the basis of AFP level (≤20, 20–200, and >200 ng/ml). RESULTSConservative candidacy group OS and tumor-free survival were better than the inclusive candidacy group. Low AST, high tumor differentiation, and low AFP were significantly associated with improved OS in the inclusive candidacy group (P