Background: This study was designed to validate the alpha-fetoprotein model for predicting recurrence after LT in Korean HCC patients.

Methods: Patients who underwent liver transplantation for HCC at Samsung Medical Center between 2007 and 2015 were included. Recurrence, overall survival, and disease-specific survival of patients divided by both the Milan criteria and the alpha-fetoprotein model were compared using Kaplan-Meier log-rank test. The predictability of the alpha-fetoprotein model compared to the Milan criteria was tested by means of net reclassification improvement analysis applied to patients with a follow-up of at least 2 years.

Results: A total of 400 patients were included in the study. Patients within Milan criteria had 5-year recurrence, overall survival, and disease-specific survival rates of 20.9%, 76.3%, and 89.4%, respectively, compared to corresponding rates of 50.3%, 55.7%, and 64.4%, respectively, for patients who were beyond Milan criteria. Alpha-fetoprotein model low risk patients had 5-year recurrence, overall survival, and disease-specific survival rates of 21.1%, 76.2%, and 89.3%, respectively, compared to corresponding rates of 57.7%, 52.2%, and 59.3%, respectively, in high risk patients (P<0.001, all). Although overall net reclassification improvements were statistically nonsignificant for recurrence (NRI=1.7%,Z=0.30,p=0.7624), overall survival (NRI=9.0%,Z=1.60,p=0.1098), and disease-specific survival (NRI=9.5%,Z=1.34,p=0.1807), they were significantly better for predicting no recurrence (NRI=6.6%,Z=3.16,p=0.0016), no death (NRI=7.7%,Z=3.65,p=0.0003), and no recurrence-related death (NRI=6.9%,Z=3.37,p=0.0007).

Conclusions: The alpha-fetoprotein model seems to be a promising tool for liver transplantation candidacy, but further investigation is needed.

CITATION INFORMATION: Rhu J., Kim J., Choi G., Kwon C., Joh J., Kim S. Validation of the alpha-Fetoprotein Model for Hepatocellular Carcinoma Recurrence after Transplantation in an Asian Population Am J Transplant. 2017;17 (suppl 3).

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