Grat M, Kornasiewicz O, Hołówko W, Lewandowski Z, Zieniewicz K, Paczek L, Krawczyk M
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Transplant Proc. 2013 Jun;45(5):1899-903. doi: 10.1016/j.transproceed.2012.12.010.
Appropriate selection of hepatocellular cancer (HCC) patients for liver transplantation is crucial to minimize the risk of recurrence and provide long-term outcomes comparable with those for other indications. Selection criteria based on total tumor volume (TTV) and α-fetoprotein (AFP) concentrations were proposed in a recent large study. The aim of this study was to evaluate the results of liver transplantation for HCC within and beyond these criteria.
This retrospective study included 104 patients with HCC who underwent liver transplantation. Risk factors for overall survival and tumor recurrence were evaluated. Overall survival and cumulative tumor recurrence rate for patients with TTV <115 cm(3), AFP concentration <400 ng/mL, and no macrovascular invasion (76/104; 73.1%) were evaluated and compared with those for the remaining patients (28/104; 26.9%).
Pretransplantation AFP concentration >400 ng/mL (P = .016; hazard ratio [HR], 3.36; 95% confidence intervals [CI], 1.25-9.03) was the only risk factor for overall survival. TTV >115 cm(3) (P = .021; HR 4.29; 95% CI, 1.24-14.81) and AFP concentration >400 ng/mL (P = .002; HR 6.97; 95% CI, 2.02-24.03) were independent risk factors for recurrence. The estimated 3-year tumor recurrence rate was 4.2% for patients with TTV <115 cm(3), AFP concentration <400 ng/mL, and no macrovascular invasion compared with 57.2% for the remaining patients (P < .00001). The 3-year overall survival rate of patients within and beyond this criteria was 81.7% and 64.6%, respectively (P = .0628).
In contrast to other criteria, selection of HCC patients for liver transplantation on the basis of TTV and AFP concentration relates to both morphological features and tumor biology. Although fulfillment of these criteria was more than 1.5-fold higher than that of the Milan criteria, the rate of tumor recurrence was exceptionally low.
为肝细胞癌（HCC）患者恰当选择肝移植受者对于将复发风险降至最低并提供与其他适应证相当的长期预后至关重要。在最近一项大型研究中提出了基于肿瘤总体积（TTV）和甲胎蛋白（AFP）浓度的选择标准。本研究旨在评估符合及不符合这些标准的HCC患者肝移植的结果。
这项回顾性研究纳入了104例行肝移植的HCC患者。评估了总生存和肿瘤复发的危险因素。对TTV<115 cm³、AFP浓度<400 ng/mL且无大血管侵犯的患者（76/104；73.1%）的总生存和累积肿瘤复发率进行了评估，并与其余患者（28/104；26.9%）进行了比较。
移植前AFP浓度>400 ng/mL（P = 0.016；风险比[HR]，3.36；95%置信区间[CI]，1.25 - 9.03）是总生存的唯一危险因素。TTV>115 cm³（P = 0.021；HR 4.29；95% CI，1.24 - 14.81）和AFP浓度>400 ng/mL（P = 0.002；HR 6.97；95% CI，2.02 - 24.03）是复发的独立危险因素。TTV<115 cm³、AFP浓度<400 ng/mL且无大血管侵犯的患者估计3年肿瘤复发率为4.2%，而其余患者为57.2%（P < 0.00001）。符合及不符合该标准的患者3年总生存率分别为81.7%和64.6%（P = 0.0628）。
与其他标准不同，基于TTV和AFP浓度为HCC患者选择肝移植受者既涉及形态学特征又涉及肿瘤生物学特性。尽管符合这些标准的比例比米兰标准高出1.5倍多，但肿瘤复发率却异常低。
