AFP Response to Locoregional Therapy Can Stratify the Risk of Tumor Recurrence in HCC Patients after Living Donor Liver Transplantation

SIMPLE SUMMARY: We evaluated the effect of AFP response to locoregional therapy (LRT) on the outcomes of hepatocellular carcinoma patients after living donor liver transplantation. The enrolled patients were divided into four groups according to LRT and AFP response to LRT. The nonresponse group had the highest 5-year cumulative recurrence rates whereas the complete-response group (patients with abnormal AFP before LRT and with normal AFP after LRT) had the lowest 5-year cumulative recurrence rates among the four groups. The 5-year cumulative recurrence rates of the partial-response group (AFP response was not back to the normal level) was comparable to the control group. AFP response to LRT can be used to stratify the risk of HCC recurrence after LDLT and also to clarify the efficacy of LRT. A better prognosis can be expected if a partial AFP response of over 15% is achieved. ABSTRACT: (1) Background: Alpha-fetoprotein (AFP) has been incorporated into the selection criteria of liver transplantation and been used to predict the outcome of hepatocellular carcinoma (HCC) recurrence. Locoregional therapy (LRT) is recommended for bridging or downstaging in HCC patients listed for liver transplantation. The aim of this study was to evaluate the effect of the AFP response to LRT on the outcomes of hepatocellular carcinoma patients after living donor liver transplantation (LDLT). (2) Methods: This retrospective study included 370 HCC LDLT recipients with pretransplant LRT from 2000 to 2016. The patients were divided into four groups according to AFP response to LRT. (3) Results: The nonresponse group had the worst 5-year cumulative recurrence rates whereas the complete-response group (patients with abnormal AFP before LRT and with normal AFP after LRT) had the best 5-year cumulative recurrence rate among the four groups. The 5-year cumulative recurrence rate of the partial-response group (AFP response was over 15% lower) was comparable to the control group. (4) Conclusions: AFP response to LRT can be used to stratify the risk of HCC recurrence after LDLT. If a partial AFP response of over 15% declineis achieved, a comparable result to the control can be expected.