Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
Department of Anaesthesiology, Klinikum Großhadern, LMU Munich, Munich, Germany.
Dig Dis Sci. 2019 Jan;64(1):269-280. doi: 10.1007/s10620-018-5296-9. Epub 2018 Sep 27.
The aim of this study was to establish a preoperatively available serological risk index using alpha-fetoprotein (AFP) and C-reactive protein (CRP) for predicting oncologically futile liver transplantation (LT) in hepatocellular carcinoma (HCC) patients.
A total of 119 liver transplant patients with HCC were retrospectively analyzed. The prognostic impact of clinical and histopathologic factors including pre-LT serum AFP and CRP values was determined.
Apart from microvascular tumor invasion (MVI; odds ratio [OR] 15.77), pretransplant serum levels of AFP > 100 ng/ml (OR 13.31) and CRP > 0.8 mg/dl (OR 13.97) were identified as independent predictors of HCC recurrence. The cumulative risk of HCC relapse at 5 years post-LT was 2.3% in low serological tumor activity (STA) index (AFP ≤ 100 ng/ml + CRP ≤ 0.8 mg/dl), 17.1% in intermediate STA (AFP ≤ 100 ng/ml or CRP ≤ 0.8 mg/dl), and 91.6% in high STA index (AFP > 100 ng/ml + CRP > 0.8 mg/dl; p < 0.001), respectively. High STA index was identified as most powerful pre-LT available predictor of MVI (OR 15.31) and posttransplant HCC recurrence (OR 54.44). Five-year recurrence-free survival rate in Milan Out patients with high STA was 0%, compared to 91.7% and 83.6% in those with low or intermediate STA index (p < 0.001), respectively.
Our proposed serological risk index based on pretransplant serum AFP and CRP values is able to predict oncologically futile LT among advanced HCC patients.
本研究旨在建立一种基于甲胎蛋白（AFP）和 C 反应蛋白（CRP）的术前血清学风险指数，以预测肝细胞癌（HCC）患者进行无肿瘤获益的肝移植（LT）。
回顾性分析了 119 例 HCC 肝移植患者。确定了包括 LT 前血清 AFP 和 CRP 值在内的临床和组织病理学因素的预后影响。
除微血管肿瘤侵犯（MVI；优势比 [OR] 15.77）外，移植前血清 AFP>100ng/ml（OR 13.31）和 CRP>0.8mg/dl（OR 13.97）被确定为 HCC 复发的独立预测因子。LT 后 5 年 HCC 复发的累积风险在低血清学肿瘤活动（STA）指数（AFP≤100ng/ml+CRP≤0.8mg/dl）组为 2.3%，在中 STA 组（AFP≤100ng/ml 或 CRP≤0.8mg/dl）为 17.1%，在高 STA 指数组（AFP>100ng/ml+CRP>0.8mg/dl）为 91.6%（p<0.001）。高 STA 指数被确定为 LT 前预测 MVI（OR 15.31）和 LT 后 HCC 复发的最有力的预测因子（OR 54.44）。高 STA 指数的米兰 OUT 患者 5 年无复发生存率为 0%，而低或中 STA 指数患者分别为 91.7%和 83.6%（p<0.001）。
我们提出的基于 LT 前血清 AFP 和 CRP 值的血清学风险指数能够预测晚期 HCC 患者进行无肿瘤获益的 LT。
