Menahem Benjamin, Duvoux Christophe, Ganne Nathalie, Mallat Ariane, Seror Olivier, Calderaro Julien, Launoy Guy, Alves Arnaud, Cherqui Daniel, Luciani Alain, Laurent Alexis
Department of Digestive Surgery, CHU de Caen, Avenue de la côte de Nacre, 14032, Caen Cedex, France.
UNICAEN, CEA, CNRS, CHU Caen, INSERM UMR1086, Centre François Baclesse, Normandie University, 3 Avenue du Général Harris, 14045, Caen Cedex, France.
World J Surg. 2019 Jan;43(1):221-229. doi: 10.1007/s00268-018-4769-5.
In 2012, the Liver Transplant French Study Group built the alpha-fetoprotein-score (AFP-score), which improved significantly the prediction of tumor recurrence in case of liver transplantation for HCC when compared to Milan criteria. The aim of the study was to test the AFP score in case of liver resection (LR) for HCC.
From 1990 to 2012, 347 patients underwent a liver resection for HCC developed on chronic liver disease (CLD). All patients with solitary HCC <60 mm were included. The primary end point was to investigate if the AFP-score at the first LR was predictive of recurrence and if recurrence occurred within the AFP-score. The secondary end points were overall survival (OS) and disease-free survival.
One hundred and eight patients fulfilled the inclusions criteria. After a median follow-up of 65.4 [13-114] months, recurrence occurred in 64.8% (70/108) patients. Among the study population, 96 were "in AFP-score" (i.e., ≤2) of whom 60.4% (58/96) developed a recurrence that was cured in curative intent. In contrast, all patients "out AFP-score" experienced recurrence, and 25% were eligible for curative treatment. At the end of the follow-up, 26 patients were listed for liver transplantation (LT). Among them, 21 were finally transplanted. The 5-year OS after salvage LT was 68.5% [50.2-93.0].
AFP-score is a useful tool for patients selection after LR for solitary HCC developed on CLD. For patients "in AFP-score," up-front LR provides good survival and allows to avoid up-front LT in case of recurrence.
2012年，法国肝移植研究小组构建了甲胎蛋白评分（AFP评分），与米兰标准相比，该评分显著改善了肝细胞癌肝移植术后肿瘤复发的预测。本研究的目的是在肝细胞癌肝切除（LR）病例中测试AFP评分。
1990年至2012年，347例因慢性肝病（CLD）发生肝细胞癌而接受肝切除的患者。纳入所有单个肝细胞癌＜60mm的患者。主要终点是研究首次肝切除时的AFP评分是否可预测复发以及复发是否发生在AFP评分范围内。次要终点是总生存期（OS）和无病生存期。
108例患者符合纳入标准。中位随访65.4 [13 - 114]个月后，64.8%（70/108）的患者出现复发。在研究人群中，96例处于“AFP评分范围内”（即≤2），其中60.4%（58/96）出现复发且接受了根治性治疗。相比之下，所有“超出AFP评分范围”的患者均出现复发，且25%的患者符合根治性治疗条件。随访结束时，26例患者被列入肝移植（LT）名单。其中，21例最终接受了移植。挽救性肝移植后的5年总生存率为68.5% [50.2 - 93.0]。
AFP评分是CLD基础上发生的单个肝细胞癌肝切除术后患者选择的有用工具。对于“处于AFP评分范围内”的患者， upfront LR可提供良好的生存率，并在复发时避免 upfront LT。
