18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描在晚期肝细胞癌活体肝移植中的临床影响

Clinical Impact of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Living Donor Liver Transplantation for Advanced Hepatocellular Carcinoma.

作者信息

Lee Seung Duk, Kim Seong Hoon, Kim Seok-Ki, Kim Young-Kyu, Park Sang-Jae

机构信息

1 Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea. 2 Department of Nuclear Medicine, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea. 3 Department of Surgery, College of Medicine, Jeju National University, Jeju-do, Republic of Korea.

出版信息

Transplantation. 2015 Oct;99(10):2142-9. doi: 10.1097/TP.0000000000000719.

DOI:10.1097/TP.0000000000000719

PMID:25905981

Abstract

BACKGROUND

The relevant number of patients with hepatocellular carcinoma (HCC) beyond the Milan criteria have undergone living donor liver transplantation (LDLT). However, the prognostic factors for these patients with advanced HCC remain unclear.

METHODS

From March 2005 to May 2013, 280 patients with HCC underwent LDLT at the National Cancer Center. Of these, patients with HCC beyond the Milan criteria were retrospectively enrolled. We analyzed the prognostic significance of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) for selecting appropriate candidates.

RESULTS

Of the total 280 patients, 147 (52.5%) were confirmed to have HCC beyond the Milan criteria on the basis of pathological reports. The patients who met and exceeded the Milan criteria had 5-year overall survival (OS) rates of 87.2% and 64.6%, respectively (P < 0.001). Multivariable analysis for OS and disease-free survival (DFS) in patients with HCC beyond the Milan criteria revealed PET/CT positivity (hazards ratio [HR], 2.714; P = 0.013 for OS; HR, 3.803; P < 0.001 for DFS), total tumor size over 10 cm (HR, 2.333; P = 0.035 for OS; HR, 3.334, P = 0.001 for DFS), and microvascular invasion (HR, 2.917; P = 0.025 for DFS) to be significant prognostic factors. In particular, patients with HCC beyond the Milan criteria with a PET/CT-negative status and total tumor size less than 10 cm showed similar OS and DFS in comparison with those with HCC within the Milan criteria.

CONCLUSIONS

A PET/CT status in LDLT is a useful marker for predicting survival of patients with advanced HCC.

摘要

背景

超过米兰标准的肝细胞癌（HCC）患者已接受活体肝移植（LDLT）。然而，这些晚期HCC患者的预后因素仍不清楚。

方法

2005年3月至2013年5月，280例HCC患者在国家癌症中心接受了LDLT。其中，对超过米兰标准的HCC患者进行回顾性纳入。我们分析了（18）F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（（18）F-FDG-PET/CT）在选择合适候选者方面的预后意义。

结果

在总共280例患者中，根据病理报告确认有147例（52.5%）HCC超过米兰标准。符合和超过米兰标准的患者5年总生存率（OS）分别为87.2%和64.6%（P<0.001）。对超过米兰标准的HCC患者的OS和无病生存率（DFS）进行多变量分析显示，PET/CT阳性（风险比[HR]，2.714；OS，P = 0.013；HR，3.803；DFS，P<0.001）、肿瘤总大小超过10 cm（HR，2.333；OS，P = 0.035；HR，3.334，DFS，P = 0.001）和微血管侵犯（HR，2.917；DFS，P = 0.025）是显著的预后因素。特别是，PET/CT阴性且肿瘤总大小小于10 cm的超过米兰标准的HCC患者与米兰标准内的HCC患者相比，OS和DFS相似。