Gugenheim Jean, Bredt Luis César, Iannelli Antonio, Decaens Thomas, Roudot-Thoraval Francoise, Meyer Carole, Durand Francois, Bernard Pierre-Henri, Boillot Olivier, Sulpice Laurent, Calmus Yvon, Hardwigsen Jean, Ducerf Christian, Pageaux Georges-Philippe, Dharancy Sebastien, Chazouilleres Olivier, Cherqui Daniel, Duvoux Christophe, Hadni-Bresson Solange
Hepatogastroenterology. 2013 Jun;60(124):799-806. doi: 10.5754/hge12997. Epub 2013 Jun 6.
BACKGROUND/AIMS: The Up7 criteria for HCC have recently emerged to identify potential candidates for OLT. The aim of this study was to assess the validity of the Up7 criteria according to the pathological analysis of the explanted livers.
For recurrence risk calculation 669 HCC transplanted patients were classified according to both the pathological Milan and Up7 criteria. In order to identify potential predictors of recurrence, selected biological tumor markers and morphological features were then tested by Cox regression.
The 5-year HCC recurrence rate for the Milan out/Up7 in subgroup (n=87), was significantly higher than patients meeting Milan criteria (n=299), 15.8% vs. 9.4% (p=0.0290). For patients within the Up7 criteria (n=383), only pre-OLT AFP level >1000ng/mL and microvascular invasion were significant predictors for recurrence, and for those beyond the Up7 criteria (n=286), pre-OLT AFP level >1000ng/mL, poor differentiation grade and microvascular invasion remained significant.
Compared to the current Milan staging system, HCC patients within the pathological Up7 criteria were associated with a higher, but acceptable risk of recurrence after OLT, and along with tumor burden, other parameters can potentially be used for further refinement of HCC staging, such as AFP levels and microvascular invasion.
背景/目的：用于肝细胞癌（HCC）的Up7标准最近已出现，以识别肝移植（OLT）的潜在候选者。本研究的目的是根据移植肝脏的病理分析评估Up7标准的有效性。
为了计算复发风险，669例接受HCC移植的患者根据病理米兰标准和Up7标准进行分类。为了确定复发的潜在预测因素，然后通过Cox回归测试选定的生物肿瘤标志物和形态学特征。
米兰标准不符合/Up7标准亚组（n = 87）的5年HCC复发率显著高于符合米兰标准的患者（n = 299），分别为15.8%和9.4%（p = 0.0290）。对于符合Up7标准的患者（n = 383），仅肝移植前甲胎蛋白（AFP）水平>1000ng/mL和微血管侵犯是复发的显著预测因素，而对于超出Up7标准的患者（n = 286），肝移植前AFP水平>1000ng/mL、低分化等级和微血管侵犯仍然具有显著性。
与当前的米兰分期系统相比，符合病理Up7标准的HCC患者肝移植后复发风险较高但仍可接受，并且除了肿瘤负荷外，其他参数如AFP水平和微血管侵犯可能可用于进一步完善HCC分期。
