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CA19-9, AFP levels predicted OS in liver transplant patients with hepatic carcinoma

Preoperative carbohydrate antigen 19-9 and alpha-fetoprotein levels measured in patients with hepatic carcinoma who underwent liver transplantation predicted overall survival and relapse-free survival rates, according to recent study data.

Researchers conducted a cohort study of 226 patients with hepatic carcinoma (mean age, 50.2 years; 84.9% men) who underwent liver transplantation (LT) in Shanghai between January 2007 and June 2010. Each patient began immunosuppressive treatment during surgery with tacrolimus or cyclosporine combined with methylprednisolone and/or mycophenolate mofeil. Before transplantation, 37.6% of patients had serum alpha-fetoprotein (AFP) levels greater than 400 ng/mL, and 14.2% had carbohydrate antigen 19-9 (CA19-9) levels greater than 100 U/mL.

The 1-year and 5-year overall survival (OS) rates among all patients were 79% and 58%, respectively; relapse-free survival (RFS) rates were 70.3% and 62.2%, respectively.

Through defining tumor marker type (TMT) researchers observed that patients with a preoperative CA19-9 level greater than 100 U/mL had lower 5-year OS (32.4% vs. 62.2%, P<.001) and 5-year RFS (35.1% vs. 66.1%, P<.001), compared with those with lower levels. Of 32 patients with high CA19-9 levels, 81.3% exceeded Milan criteria for transplant selection; overall 119 patients did not meet Milan criteria. Patients with preoperative AFP levels at 400 ng/mL or lower had a greater 5-year OS (69.5% vs. 38.7%, P<.001) and RFS (76.1% vs. 40.3%, P<.001), compared with patients with greater AFP levels.

In Cox regression models, researchers identifed14 variables that could affect OS or RFS in hepatic carcinoma patients, including histopathologic grading and primary or salvage LT. In addition, the models labeled tumor size, TMT, and extrahepatic invasion as independent predictors for OS and RFS.

“This study shows that the combination of AFP and CA19-9 is able to predict overall OS and RFS of hepatic carcinoma patients after LT and that TMT based on preoperative serum levels of AFP and CA19-9 could be a useful tool to select hepatic carcinoma patients for LT, especially those exceeding the Milan criteria,” the researchers wrote.

Disclosure: Researcher Qiang Xia reports receiving grants from the Training Program for Superb Academic Leaders in Shanghai Health System and the Special Fund for Building of Leading Talent Teams.