Department of Surgery, University of Alberta, Edmonton, Canada.
J Hepatol. 2011 Oct;55(4):814-9. doi: 10.1016/j.jhep.2010.12.040. Epub 2011 Feb 18.
BACKGROUND & AIMS: Liver transplantation is a recognized treatment for selected patients with hepatocellular carcinoma (HCC), but transplant criteria still need to be refined, especially in the case of more advanced or downstaged tumors.
The present study investigated alpha-fetoprotein (AFP) as a predictor of outcome in 6817 patients listed with a diagnosis of HCC in the Scientific Registry of Transplant Recipients.
Local pre-transplant HCC treatment was used in 41% of patients on the waiting list. Patients with AFP levels>400 ng/ml at the time of listing who were downstaged to AFP ≤400 ng/ml had better intent-to-treat survival than patients failing to reduce AFP to ≤400 (81% vs. 48% at 3 years, p ≤0.001) and comparable survival to patients with stable AFP ≤400 ng/ml (74%, p = 0.14). Patients with AFP levels decreased ≤400 ng/ml and patients with levels persistently ≤400 ng/ml also had similar drop-out rates from the list (10% in both groups) and post-transplant survival rates (89% vs. 78% at 3 years, p = 0.11). Such an AFP downstaging was associated with good survivals whatever the level of the original AFP (even if originally>1000 ng/ml). Only the last pre-transplant AFP independently predicted survival (p ≤0.001), unlike AFP at listing or AFP changes.
Overall, downstaging HCC patients with high AFP is feasible and leads to similar intent-to-treat and post-transplant survivals to those of patients with AFP persistently low. Only last AFP appears relevant for patient selection before transplantation and should be used in combination with morphological variables.
肝移植是治疗特定肝细胞癌（HCC）患者的一种公认方法，但仍需完善移植标准，尤其是在肿瘤更晚期或降期的情况下。
本研究调查了在移植受者科学注册处被诊断为 HCC 的 6817 例患者中，甲胎蛋白（AFP）作为预后预测因子的作用。
在等待名单上的 41%患者接受了局部移植前 HCC 治疗。在 AFP 水平>400ng/ml 的患者中，有 48%未能将 AFP 降至≤400ng/ml，其治疗意向生存优于 AFP 下降至≤400ng/ml 的患者（3 年时为 81%，p≤0.001），与 AFP 稳定在≤400ng/ml 的患者（74%，p=0.14）相当。AFP 水平下降≤400ng/ml 和 AFP 水平持续≤400ng/ml 的患者也有相似的名单淘汰率（两组均为 10%）和移植后生存率（3 年时为 89%比 78%，p=0.11）。无论 AFP 的原始水平如何（即使最初>1000ng/ml），这种 AFP 降期都与良好的生存相关。只有最后一次 AFP 独立预测生存（p≤0.001），与 AFP 水平和 AFP 变化不同。
总体而言，对 AFP 高的 HCC 患者进行降期是可行的，其治疗意向和移植后生存与 AFP 持续低的患者相似。只有最后一次 AFP 对移植前患者选择具有相关性，应与形态学变量结合使用。
