Lee Seung Duk, Lee Bora, Kim Seong Hoon, Joo Jungnam, Kim Seok-Ki, Kim Young-Kyu, Park Sang-Jae
Seung Duk Lee, Seong Hoon Kim, Sang-Jae Park, Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang 10408, South Korea.
World J Transplant. 2016 Jun 24;6(2):411-22. doi: 10.5500/wjt.v6.i2.411.
To expand the living donor liver transplantation (LT) pool of eligible patients with hepatocellular carcinoma (HCC) using new morphological and biological criteria.
Patients with HCC who underwent living donor LT (LDLT) from March 2005 to May 2013 at the National Cancer Center Korea (NCCK) were enrolled. We performed the (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) before LDLT. Overall and disease-free survival analysis was done in patients to evaluate the usefulness of new NCCK criteria using PET/CT and total tumor size (10 cm).
We enrolled a total of 280 patients who pathologically confirmed to have HCC and performed the PET/CT before transplantation. Among them, 164 (58.6%) patients fulfilled the NCCK criteria and 132 patients (47.1%) met the Milan criteria. Five-year overall and disease-free survival rates for patients who fulfilled the NCCK criteria showed 85.2% and 84.0%, respectively, and were significantly higher than those beyond the NCCK criteria (60.2% and 44.4%, respectively; P < 0.001). The correlation analysis between preoperative imaging tests and pathologic reports using Cohen's Kappa demonstrated the better results in the NCCK criteria than those in the Milan criteria (0.850 vs 0.583). The comparison of disease-free analysis among the NCCK, Milan, and University of California, San Francisco (UCSF) criteria using the receiver operating characteristics curves revealed the similar area under the curve value criteria (NCCK vs Milan, P = 0.484; NCCK vs UCSF, P = 0.189 at 5-years).
The NCCK criteria using hybrid concept of both morphological and biological parameters showed an excellent agreement between preoperative imaging and pathological results, and favorable survival outcomes. These new criteria might select the optimal patients with HCC waiting LDLT and expand the selection pool.
运用新的形态学和生物学标准扩大符合条件的肝细胞癌（HCC）患者活体肝移植（LT）的供体库。
纳入2005年3月至2013年5月在韩国国立癌症中心（NCCK）接受活体肝移植（LDLT）的HCC患者。在LDLT前进行（18）F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT）。对患者进行总生存和无病生存分析，以评估使用PET/CT和肿瘤总大小（10 cm）的新NCCK标准的实用性。
共纳入280例经病理证实患有HCC且在移植前进行了PET/CT的患者。其中，164例（58.6%）患者符合NCCK标准，132例（47.1%）患者符合米兰标准。符合NCCK标准患者的5年总生存率和无病生存率分别为85.2%和84.0%，显著高于超出NCCK标准的患者（分别为60.2%和44.4%；P<0.001）。使用Cohen's Kappa对术前影像学检查与病理报告进行相关性分析，结果显示NCCK标准比米兰标准更好（0.850对0.583）。使用受试者工作特征曲线对NCCK、米兰和加利福尼亚大学旧金山分校（UCSF）标准进行无病分析比较，结果显示5年时曲线下面积值标准相似（NCCK对米兰，P = 0.484；NCCK对UCSF，P = 0.189）。
采用形态学和生物学参数混合概念的NCCK标准在术前影像学和病理结果之间显示出极好的一致性，且生存结果良好。这些新标准可能会筛选出等待LDLT的最佳HCC患者并扩大选择范围。
