Kashkoush Samy, El Moghazy Walid, Kawahara Toshiyasu, Gala-Lopez Boris, Toso Christian, Kneteman Norman M
Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, AB, Canada; Department of Surgery, National Liver Institute, Menofiya University, Menofiya, Egypt.
Clin Transplant. 2014 Jun;28(6):728-36. doi: 10.1111/ctr.12373. Epub 2014 May 10.
Total tumor volume (TTV), as a better predictor of hepatocellular carcinoma (HCC) recurrence after liver transplant, has been explored by our center. Some tumors are not typically spherical but rather ellipsoid or spheroid, and calculating their TTV based on one dimension only may overestimate their volume and exclude them from candidacy for transplantation. Our aim was to study the actual tumor volume (ATV) calculated using the ellipsoid formula and assess its impact on recurrence. HCC patients transplanted between 1990 and 2010 at University of Alberta Hospital were analyzed. Tumor volumes were calculated using both formulas: [(4/3) πr(3)] (r = max. radius) and [(4/3) πabc] (a, b, c = the 3 radiuses). A total of 115 patients were included with a mean follow-up of 4.99 ± 4.23 yr. Five-yr recurrence-free survival was 79.8%. Univariate analysis for predictors of recurrence included: maximum tumor diameter, ATV, TTV, and alpha-fetoprotein (AFP) ≥ 400 ng/mL. Multivariate analysis showed that ATV and AFP ≥ 400 ng/mL were the only predictors of recurrence. Combining both variables provides better predication of recurrence with accuracy that exceeds 80%. Three-dimensional calculation of tumor volume is of critical importance for the group of patients with ellipsoid tumors where volumes are overestimated with the spherical formula and could lead to inappropriate exclusion from transplant.
我们中心对总肿瘤体积（TTV）作为肝移植后肝细胞癌（HCC）复发的更好预测指标进行了探索。一些肿瘤并非典型的球形，而是椭圆形或类球形，仅基于一个维度计算其TTV可能会高估其体积，并将它们排除在移植候选范围之外。我们的目的是研究使用椭球体公式计算的实际肿瘤体积（ATV），并评估其对复发的影响。对1990年至2010年间在阿尔伯塔大学医院接受移植的HCC患者进行了分析。使用两种公式计算肿瘤体积：[(4/3)πr(3)]（r =最大半径）和[(4/3)πabc]（a、b、c =三个半径）。共纳入115例患者，平均随访4.99±4.23年。5年无复发生存率为79.8%。复发预测因素的单变量分析包括：最大肿瘤直径、ATV、TTV和甲胎蛋白（AFP）≥400 ng/mL。多变量分析显示，ATV和AFP≥400 ng/mL是复发的唯一预测因素。将这两个变量结合起来能更好地预测复发，准确率超过80%。对于椭圆形肿瘤患者群体，肿瘤体积的三维计算至关重要，因为球形公式会高估其体积，可能导致不恰当地将其排除在移植范围之外。
