The predictive value of the modified AFP model for liver transplantation outcomes in multinodular hepatocellular carcinoma patients

World J Surg Oncol. 2023 Mar 27;21(1):104. doi: 10.1186/s12957-023-02994-y.

Abstract

Background: There is a lack of studies focusing on the benefit of liver transplantation (LT) in hepatocellular carcinoma (HCC) patients with > 3 tumors. This study aims to establish a model to effectively predict overall survival in Chinese HCC patients with multiple tumors (> 3 tumors) who undergo LT.

Methods: This retrospective study included 434 HCC liver transplant recipients from the China Liver Transplant Registry. All HCC patients had more than 3 tumor nodules. Three selection criteria systems (i.e., AFP, Metroticket 2.0, and Up-to-7) were compared regarding the prediction of HCC recurrence. The modified AFP model was established by univariate and multivariate competing risk analyses.

Results: The AFP score 2 and the AFP score ≥ 3 groups had 5-year recurrence rates of 19.6% and 40.5% in our cohort. The prediction of HCC recurrence based on the AFP model was associated with a c-statistic of 0.606, which was superior to the Up-to-7 and Metroticket 2.0 models. AFP level > 1000 ng/mL, largest tumor size ≥ 8 cm, vascular invasion, and MELD score ≥ 15 were associated with overall survival. The 5-year survival rate in the modified AFP score 0 group was 71.7%.

Conclusions: The AFP model is superior in predicting tumor recurrence in HCC patients with > 3 tumors prior to LT. With the modified AFP model, patients likely to derive sufficient benefit from LT can be identified.

Keywords: AFP model; Hepatocellular carcinoma; Liver transplantation.

MeSH terms

  • Carcinoma, Hepatocellular* / surgery
  • Humans
  • Liver Neoplasms* / surgery
  • Liver Transplantation*
  • Neoplasm Recurrence, Local / pathology
  • Retrospective Studies
  • Risk Factors
  • alpha-Fetoproteins / analysis

Substances

  • alpha-Fetoproteins