Zhang Wei, Kim Richard, Quintini Cristiano, Hashimoto Koji, Fujiki Masato, Diago Teresa, Eghtesad Bijan, Miller Charles, Fung John, Tan Ann, Menon K V Narayanan, Aucejo Federico
Hepatobiliary & Liver Transplant Surgery; Hepatic Surgery Center, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Liver Transpl. 2015 Jan;21(1):101-11. doi: 10.1002/lt.24013.
Vascular endothelial growth factor (VEGF) is pivotal in the development of hepatocellular carcinoma (HCC). Studies have demonstrated the prognostic value of circulating VEGF levels in patients undergoing liver resection or locoregional therapy (LRT) for HCC. We investigated the significance of preoperative plasma VEGF levels in patients with HCC undergoing liver transplantation (LT) at a Western transplant center. Pre-LT plasma VEGF levels were measured with an enzyme-linked immunoassay for 164 patients with HCC undergoing LT. The preoperative plasma VEGF level was correlated with clinicopathological variables and overall and recurrence-free post-LT survival. A higher pre-LT plasma VEGF level was significantly associated with pre-LT LRT (P = 0.01), multiple tumors (P = 0.02), a total tumor diameter ≥ 5 cm (P = 0.01), bilobar tumor distribution (P = 0.03), tumor vascular invasion (VI; P < 0.001), and HCC beyond the Milan criteria (P < 0.001). Patients with a plasma VEGF level > 44 pg/mL had significantly worse overall and disease-free survival than those with VEGF levels ≤ 44 pg/mL (P = 0.04 and P = 0.02, respectively). In a multivariate analysis, a plasma VEGF level > 44 pg/mL was independently associated with tumor VI (P < 0.001) and recurrence-free survival (hazard ratio = 2.12, 95% confidence interval = 1.08-4.14, P = 0.03). In conclusion, in patients with chronic end-stage liver disease and HCC, a pre-LT plasma VEGF level > 44 pg/mL may be a predictor of tumor VI and recurrence-free post-LT survival.
血管内皮生长因子（VEGF）在肝细胞癌（HCC）的发展中起关键作用。研究已证明循环VEGF水平在接受肝切除或局部区域治疗（LRT）的HCC患者中的预后价值。我们在一家西方移植中心调查了接受肝移植（LT）的HCC患者术前血浆VEGF水平的意义。采用酶联免疫吸附测定法对164例接受LT的HCC患者术前血浆VEGF水平进行了检测。术前血浆VEGF水平与临床病理变量以及LT后的总生存期和无复发生存期相关。较高的术前血浆VEGF水平与术前LRT（P = 0.01）、多发肿瘤（P = 0.02）、肿瘤总直径≥5 cm（P = 0.01）、双叶肿瘤分布（P = 0.03）、肿瘤血管侵犯（VI；P < 0.001）以及超出米兰标准的HCC（P < 0.001）显著相关。血浆VEGF水平> 44 pg/mL的患者的总生存期和无病生存期明显比VEGF水平≤44 pg/mL的患者差（分别为P = 0.04和P = 0.02）。在多变量分析中，血浆VEGF水平> 44 pg/mL与肿瘤VI（P < 0.001）和无复发生存期独立相关（风险比= 2.12，95%置信区间= 1.08 - 4.14，P = 0.03）。总之，在慢性终末期肝病和HCC患者中，术前血浆VEGF水平> 44 pg/mL可能是肿瘤VI和LT后无复发生存期的一个预测指标。
