Department of Surgery, Klinikum rechts der Isar, Technical University, Munich, Germany.
Department of Anaesthesiology, Klinikum Großhadern, LMU, Munich, Germany.
Sci Rep. 2017 Oct 26;7(1):14176. doi: 10.1038/s41598-017-14430-9.
The Up-to-seven (UTS) criteria (sum of tumor size and number not exceeding 7) for indicating liver transplantation (LT) in hepatocellular carcinoma (HCC) were originally based on explant pathology features and absence of microvascular invasion (MVI). F-fludeoxyglucose (F-FDG) positron emission tomography (PET) was shown to indicate the risk of MVI and tumor recurrence. The aim of this study was to analyze the prognostic significance of the clinical UTS criteria when being combined with PET-status of the tumor. Data of 116 liver transplant patients were subject to retrospective analysis. Five-year recurrence-free survival (RFS) rates in patients meeting (n = 85) and exceeding (n = 21) the radiographic UTS criteria were 81% and 55.1%, respectively (p = 0.014). In the UTS In subset, RFS was significantly better in PET-negative (94.9%) than in PET-positive patients (48.3%; p < 0.001). In the UTS Out subset, 5-year RFS rates were 87.1% and 19% in patients with non- F-FDG-avid and F-FDG-avid tumors (p < 0.001), respectively. Positive PET-status was identified as the only independent clinical predictor of tumor recurrence in beyond UTS patients (Hazard ratio [HR] 19.25; p < 0.001). Combining radiographic UTS criteria with FDG-PET may safely expand the HCC selection criteria for LT.
七要素（肿瘤大小和数量总和不超过 7）标准最初是基于肝移植（LT）肝癌（HCC）的移植标本病理学特征和微血管侵犯（MVI）缺失而制定的。氟代脱氧葡萄糖（F-FDG）正电子发射断层扫描（PET）显示可预测 MVI 和肿瘤复发的风险。本研究旨在分析肿瘤的 PET 状态与临床 UTS 标准相结合的预后意义。对 116 例肝移植患者的数据进行回顾性分析。符合（n=85）和超过（n=21）影像学 UTS 标准的患者的 5 年无复发生存（RFS）率分别为 81%和 55.1%（p=0.014）。在 UTS In 亚组中，PET 阴性患者（94.9%）的 RFS 明显好于 PET 阳性患者（48.3%；p<0.001）。在 UTS Out 亚组中，非 F-FDG 摄取和 F-FDG 摄取肿瘤患者的 5 年 RFS 率分别为 87.1%和 19%（p<0.001）。PET 阳性状态被确定为超出 UTS 患者肿瘤复发的唯一独立临床预测因素（危险比[HR] 19.25；p<0.001）。将影像学 UTS 标准与 FDG-PET 相结合，可以安全地扩大 HCC 选择 LT 的标准。
