AFP-L3, DCP predict HCC recurrence after liver transplant

Dual positivity for alpha-fetoprotein (AFP) bound to Lens culinaris agglutinin (AFP-L3) ≥15 percent and des-gamma-carboxyprothrombin (DCP) ≥7.5 can strongly predict majority of early hepatocellular carcinoma (HCC) recurrences following liver transplantation (LT), suggests a study.

Consecutive patients with HCC (n=285; median age 67 years) who underwent LT (within or down-staged to Milan criteria) between 2017 and 2022 were included in this prospective cohort study. The investigators obtained pretransplant AFP, AFP-L3, and DCP measurements. The ability of biomarkers to predict HCC recurrence-free survival served as the primary endpoint.

The median biomarker values at LT were AFP 5.0 ng/ml, AFP-LS 6.7 percent, and DCP 1.0 ng/ml. Of the patients, 94.7 percent received pre-LT locoregional therapy, and 6.3 percent (n=18) had HCC recurrence after a median post-LT follow-up of 3.1 years.

AFP-LS and DCP had C-statistics of 0.81 and 0.86, respectively, outperforming AFP at just 0.74. A dual-biomarker combination of AFP-L3 ≥15 percent and DCP ≥7.5 successfully predicted 61.1 percent of HCC recurrences. On the other hand, HCC recurred in only seven patients (2.6 percent) who did not meet this threshold.

At 3 years post-LT, the Kaplan-Meier recurrence free survival rate was 43.7 percent for patients with dual positive biomarkers compared with 97.0 percent for others (p<0.001).

“This model could refine LT selection criteria and identify high-risk patients who require additional locoregional therapy prior to LT,” the investigators said.