Sotiropoulos Georgios C, Malago Massimo, Machairas Nikolaos, Fouzas Ioannis, Paul Andreas
Department of General Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
Department of General Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
Transplant Proc. 2019 Jul-Aug;51(6):1923-1925. doi: 10.1016/j.transproceed.2019.05.015.
Hepatocellular carcinoma (HCC) in cirrhosis represents one of the leading indications for liver transplant. In an effort to expand the listing criteria, a variety of scoring systems have been suggested, mainly based on the tumor number/size criterion. The objective of our study was to evaluate the feasibility of proposing a transplant score for HCC excluding the tumor number/size criterion.
Data corresponding to patients who received transplants because of HCC were reviewed for the purposes of this study. Deceased donor and living donor liver transplants were included. Demographic, clinical and tumor-related parameters were evaluated. Uni- and multivariate regression analyses and survival analysis were performed.
One hundred patients were included in the study. Fifty-five patients underwent deceased donor liver transplant, and 45 patients received living donor liver transplants. Tumor differentiation (G1/2 vs G3), alpha-fetoprotein levels (AFP), recipient age, and recipient laboratory Model for End-Stage Liver Disease Score (MELD) showed statistical significance. A scoring system was developed, with prognostic points assigned as follows: age 60 years or younger:age older than 60 years = 1:0 points, tumor grading well or moderate:tumor grading poor = 1:0 points, MELD score ≤22:MELD score >22 = 1:0 points, and AFP level ≤400 ng/mL:AFP level >400 ng/mL = 1:0 points. This stratification delineated 3 separate population samples corresponding to patients with scores of 4, 3, and 1 to 2, respectively. The calculated 5-year survival for scores 4, 3, and 1 to 2 was 76%, 47%, and 20%, respectively (P < .001).
The AGMA score (age, grading, MELD, AFP) showed prognostic value in this single-center analysis and may find clinical implication avoiding the tumor number/size criterion.
肝硬化患者的肝细胞癌（HCC）是肝移植的主要适应证之一。为了扩大列入移植名单的标准，人们提出了多种评分系统，主要基于肿瘤数量/大小标准。我们研究的目的是评估在不考虑肿瘤数量/大小标准的情况下，提出一种HCC移植评分的可行性。
为了本研究的目的，回顾了因HCC接受移植患者的数据。纳入了尸体供肝和活体供肝肝移植患者。评估了人口统计学、临床和肿瘤相关参数。进行了单因素和多因素回归分析以及生存分析。
本研究纳入了100例患者。55例患者接受了尸体供肝肝移植，45例患者接受了活体供肝肝移植。肿瘤分化程度（G1/2与G3）、甲胎蛋白水平（AFP）、受者年龄以及受者终末期肝病模型评分（MELD）具有统计学意义。开发了一种评分系统，预后评分分配如下：年龄60岁及以下：年龄大于60岁 = 1:0分，肿瘤分级良好或中等：肿瘤分级差 = 1:0分，MELD评分≤22：MELD评分>22 = 1:0分，AFP水平≤400 ng/mL：AFP水平>400 ng/mL = 1:0分。这种分层划分出了3个独立的人群样本，分别对应评分为4分、3分以及1至2分的患者。评分4分、3分以及1至2分的患者计算得出的5年生存率分别为76%、47%和20%（P <.001）。
AGMA评分（年龄、分级、MELD、AFP）在这项单中心分析中显示出预后价值，并且在不考虑肿瘤数量/大小标准的情况下可能具有临床意义。
