甲胎蛋白和 (18)F-FDG 正电子发射断层扫描比米兰标准更能预测活体供肝移植中的肿瘤复发。
Alpha-fetoprotein and (18)F-FDG positron emission tomography predict tumor recurrence better than Milan criteria in living donor liver transplantation.
机构信息
Department of Surgery, Ewha Womans University, School of Medicine, South Korea.
Department of Surgery, Seoul National University, College of Medicine, South Korea.
出版信息
J Hepatol. 2016 Apr;64(4):852-9. doi: 10.1016/j.jhep.2015.11.033. Epub 2015 Nov 30.
BACKGROUND & AIMS: Given the organ shortage for liver transplantation (LT) and the limitations of the current morphology-based selection criteria, improved criteria are needed to achieve the maximum benefit of LT for hepatocellular carcinoma (HCC). We hypothesized that a combination of biological markers may better predict the prognosis than the Milan criteria.
METHODS
HCC patients (n=123) with preoperative data on serum alpha-fetoprotein (AFP) levels and (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) positivity underwent live-donor LT between January 2003 and December 2009. The cut-off values for serum AFP levels (200 ng/ml) and (18)F-FDG PET positivity (1.10) for tumor recurrence were determined by c-statistics using receiver operating characteristic curves. Univariate and multivariate analyses with preoperative variables were performed to find pre-transplant prognostic factors. Disease-free survival rates and overall survival rates were analysed with regard to serum AFP levels and (18)F-FDG PET positivity.
RESULTS
The 5-year disease-free survival rates and overall survival rates were 80.3% and 81.6% respectively. (18)F-FDG PET positivity (hazard ratio (HR) 9.766, 95% CI 3.557-26.816; p<0.001) and serum AFP level (HR 6.234, 95% CI 2.643-14.707; p<0.001) were the only significant pre-transplant prognostic factors in the multivariate analysis; tumor number and size were not significant. A combination of criteria showed that the biologically high-risk group (AFP level ⩾200 ng/ml and PET-positive) had an HR of 29.069 (95% CI 8.797-96.053; p<0.001) compared with the double-negative group. Use of the Milan criteria yielded an HR of 1.351 (95% CI 0.500-3.652; p=0.553).
CONCLUSIONS
The combination of the serum AFP level and (18)F-FDG PET data predicted better outcomes than those using the Milan criteria, improving objectivity when adult-to-adult living donor LT is contemplated.
背景与目的
鉴于肝移植 (LT) 的器官短缺和当前形态学选择标准的局限性，需要改进标准以最大程度地受益于肝细胞癌 (HCC) 的 LT。我们假设生物标志物的组合可能比米兰标准更好地预测预后。
方法
2003 年 1 月至 2009 年 12 月期间，对接受术前血清甲胎蛋白 (AFP) 水平和（18）F-氟脱氧葡萄糖正电子发射断层扫描 ((18)F-FDG PET) 阳性的活体供者 LT 的 HCC 患者（n=123）进行了研究。使用受试者工作特征曲线的 c 统计量确定血清 AFP 水平（200ng/ml）和（18）F-FDG PET 阳性（1.10）的截断值，用于肿瘤复发。使用术前变量进行单变量和多变量分析，以确定移植前的预后因素。分析血清 AFP 水平和（18）F-FDG PET 阳性与无病生存率和总生存率的关系。
结果
5 年无病生存率和总生存率分别为 80.3%和 81.6%。（18）F-FDG PET 阳性（危险比 (HR) 9.766，95%置信区间 3.557-26.816；p<0.001）和血清 AFP 水平（HR 6.234，95%置信区间 2.643-14.707；p<0.001）是多变量分析中唯一显著的移植前预后因素；肿瘤数量和大小无显著意义。标准的组合表明，生物学高危组（AFP 水平 ⩾200ng/ml 且 PET 阳性）的 HR 为 29.069（95%置信区间 8.797-96.053；p<0.001），而双阴性组的 HR 为 1.351（95%置信区间 0.500-3.652；p=0.553）。
结论
血清 AFP 水平和（18）F-FDG PET 数据的组合比米兰标准预测更好的结果，在考虑成人对成人活体供者 LT 时提高了客观性。
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