Monday, April 16, 2012

Alpha-fetoprotein levels are prognostic after liver transplants for hepatocellular carcinoma

Alpha-fetoprotein levels are prognostic after liver transplants for hepatocellular carcinoma
A study in the most recent issue of the Alimentary Pharmacology & Therapeutics investigates the prognostic role of alpha-fetoprotein following liver transplantation for hepatocellular carcinoma.

Liver transplantation offers a possible cure for carefully selected patients with hepatocellular carcinoma.

Studies report that preoperative alpha-fetoprotein is a prognostic indicator that can predict survival and recurrence in these patients.

Dr Prasad and colleagues from the United Kingdom systematically reviewed available literature on preoperative alpha-fetoprotein as a predictor of survival and recurrence following liver transplantation for hepatocellular carcinoma.

A literature search was performed using Medline, Embase, Cochrane Library, CINAHL and Google scholar databases to identify studies reporting alpha-fetoprotein as a prognostic marker in liver transplantation for hepatocellular carcinoma.

Primary outcomes of interest were overall survival and recurrence.
Rates of vascular invasion were higher with high pre-liver transplant alpha-fetoprotein levels
Alimentary Pharmacology & Therapeutics
The team correlated secondary outcomes of pre-liver transplantation alpha-fetoprotein with vascular invasion and grade of tumor differentiation.

A total of 13 studies met the inclusion criteria.
The research team reported that the majority were male.
All were observational studies and only one prospective.
Methodological quality was rated as poor for all studies, with selection and observer bias apparent for most cohorts.

The team observed that reported survival rates and recurrence rates varied widely between the studies although overall demonstrated better outcomes for those with lower pre-liver transplant alpha-fetoprotein levels.

Similarly, rates of vascular invasion and poor tumor differentiation were higher in those with high pre-liver transplantation alpha-fetoprotein levels.

Dr Prasad's team concluded, "A quantity of alpha-fetoprotein more than 1000 ng/mL is associated with poorer outcomes from liver transplantation for hepatocellular carcinoma."

"The quality of studies was generally poor and precluded valid statistical meta-analysis."

"There is a need to improve the performance and reporting of primary prognostic studies to facilitate high quality systematic review and meta-analysis."

Aliment Pharmacol Ther 2012: 35(9): 987–999


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