Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, Munich, Germany.
Liver Transpl. 2012 Jan;18(1):53-61. doi: 10.1002/lt.22416.
There is increasing evidence that a relevant number of patients with hepatocellular carcinoma (HCC) exceeding the Milan criteria may benefit from liver transplantation (LT). We retrospectively analyzed the prognostic significance of [(18) F]fludeoxyglucose ([(18) F]FDG) positron emission tomography (PET) for identifying appropriate LT candidates with advanced HCC on clinical staging. Between 1995 and 2008, 111 patients with HCC were listed for LT. All underwent a pretransplant PET evaluation. LT was performed for 91 of these patients. The tumor recurrence rate after LT was 3.6% for patients with non-[(18) F]FDG-avid (PET(-) ) tumors, but it was 54.3% for patients with [(18) F]FDG-avid (PET(+) ) tumors (P < 0.001). The 5-year recurrence-free survival rates were comparable for patients with tumors meeting the Milan criteria (86.2%) and patients with PET(-) HCC exceeding the Milan criteria (81%) at LT, but these rates were significantly higher than the rate for liver recipients with [(18) F]FDG-avid advanced HCC (21%, P = 0.002). In a multivariate analysis, negative PET findings (odds ratio = 21.6, P < 0.001), an alpha-fetoprotein level <400 IU/mL (odds ratio = 3.3, P = 0.013), and a total tumor diameter <10 cm (odds ratio = 3.0, P = 0.022) were identified as pretransplant prognostic variables for recurrence-free survival. A PET(+) status was assessed as the only independent clinical predictor of tumor-related patient dropout from the waiting list (hazard ratio = 5.7, P = 0.01). Patients with non-[(18) F]FDG-avid HCC beyond the Milan criteria according to clinical staging may achieve excellent long-term recurrence-free survival after LT.
越来越多的证据表明，超出米兰标准的相当数量的肝细胞癌 (HCC) 患者可能从肝移植 (LT) 中获益。我们回顾性分析了 [(18) F]氟脱氧葡萄糖 ([(18) F]FDG) 正电子发射断层扫描 (PET) 在临床分期中识别合适的晚期 HCC LT 候选者的预后意义。1995 年至 2008 年间，有 111 例 HCC 患者被列入 LT 名单。所有患者均接受了移植前 PET 评估。其中 91 例患者接受了 LT。LT 后肿瘤复发率为非 [(18) F]FDG 无摄取 (PET(-)) 肿瘤患者的 3.6%，但 [(18) F]FDG 摄取 (PET(+)) 肿瘤患者的复发率为 54.3%（P < 0.001）。符合米兰标准的患者（86.2%）和超出米兰标准的 PET(-) HCC 患者（81%）的 5 年无复发生存率相当，但这些比率明显高于 [(18) F]FDG 阳性晚期 HCC 的肝接受者（21%，P = 0.002）。在多变量分析中，阴性 PET 结果（优势比 = 21.6，P < 0.001）、甲胎蛋白水平 <400 IU/mL（优势比 = 3.3，P = 0.013）和总肿瘤直径 <10 cm（优势比 = 3.0，P = 0.022）被确定为无复发生存的移植前预后变量。PET(+) 状态被评估为肿瘤相关患者从候补名单中脱落的唯一独立临床预测因子（危险比 = 5.7，P = 0.01）。根据临床分期，超出米兰标准的非 [(18) F]FDG 摄取 HCC 患者在 LT 后可能获得优异的长期无复发生存率。
