Published online Jul 28, 2015. doi: 10.4254/wjh.v7.i15.1899
Peer-review started: January 2, 2015
First decision: January 20, 2015
Revised: June 9, 2015
Accepted: June 15, 2015
Article in press: June 16, 2015
Published online: July 28, 2015
Alpha-fetoprotein (AFP) behavior in patients with hepatocellular carcinoma (HCC) waiting for liver transplant (LT) represents a perfect biological example of a fractal model in which its progressive modification and possible future prediction of its values are very hard to capture. As a consequence, AFP represents a useful but poorly manageable tool to increase the ability to better select HCC patients waiting for LT. Trying to find a “fil-rouge” in the recent literature, no definitive answers can be done to several open questions: (1) the best AFP value to adopt; (2) the best cut-off measurement; and (3) the best way to comfortably capture the effective, time-related, fluctuations of this biological marker. More, structured and prospective, studies using serial determination of AFP values within and without the context of locoregional therapies are needed in order to find the “ideal” (static and dynamic) cut-off values allowing to respond to all the still open questions in this field of transplant oncology.
Core tip: Alpha-fetoprotein (AFP) behavior in patients with hepatocellular carcinoma waiting for liver transplant (LT) represents a perfect example of a fractal model. Consequently, AFP represents a useful but poorly manageable selection tool for patients waiting for LT. Looking at the recent literature, we can assume that: (1) last AFP value seem to be the best values to adopt; (2) different cut-offs may be adopted in the two different scenarios of Milan Criteria (MC) IN and MC OUT status; (3) AFP cut-off of 1000 ng/mL represent a good compromise for MC-IN patients; and (4) no definitive conclusion has been reached in relation to MC-OUT patients.