Evaluation the Post-Transplant Survival in Hepatocellular Carcinoma Relative to the Cirrhosis and Alpha-Fetoprotein Levels in Patients with Liver Transplantation

Abstract

Background: Hepatocellular carcinoma (HCC) is the 4^th leading cause of cancer-related deaths worldwide. Unlike other solid tumors, the underlying-cause of cirrhosis can affect the prognosis in HCC.

Objective: To assess the post-transplant survival factors in patients with hepatocellular carcinoma relative to the cirrhosis and alpha-fetoprotein levels in patients with liver transplantation in Abu-Ali Sina transplant hospital, Shiraz, 2010-2020.

Methods: In this retrospective study, demographic and clinical data affecting survival includes the underlying cause of cirrhosis and alpha-fetoprotein (AFP) levels were collected from all patients (n=160) who underwent transplantation in Shiraz between 2010 and 2020 with a definitive diagnosis of hepatocellular carcinoma. The one-, two-, three-, four- and five-years survival rates and the median survival time were calculated. Kaplan-Meier method was used to determine survival at different time intervals to determine the factors affecting survival.

Results: The mean age of the study population was 51±14 years and most patients were men (82.5%). At the time of data collection, 109 patients were alive (68.1%), 22 patients died from recurrence hepatocellular carcinoma (13.8%) and 29 patients had deaths from underlying diseases (18.1%). The most common causes of cirrhosis were HBV (49.4%) and HCV (10%), respectively. 102 patients had liver cancer due to hepatitis-related factors (63.7%) and the prevalence of biliary and other diseases as the underlying cause of HCC was 5% and 31.3%, respectively. 55.6% of patients who died of hepatic impairment had AFP less than 500 ng / dl and 8 patients (44.4%) had AFP more than 500 ng / dl and blood AFP level was significantly associated with mortality (P=0.003).

The prevalence of recurrence HCC death was also higher in people with AFP above 500 (29.6% vs. 9.17%). Survival rates of 1, 2, 3, 4 and 5 years were 0.86, 0.71, 0.61, 0.41 and 0.36, respectively. Survival in AFP <500 and AFP> 500 was almost the same until 40 months and after that survival time was significantly higher in individuals with AFP <500 (P-value = 0.06).

Conclusion: The present study showed that gender and the underlying causes of cirrhosis do not have a significant effect on determining the patient’s survival rate and the only factor affecting was AFP which is a predictive and prognostic biomarker as a tumor antigen role in HCC.