甲胎蛋白和 F-FDG 标准摄取值可预测伴有门静脉癌栓的肝细胞癌肝移植术后肿瘤复发：初步经验。

Alpha-fetoprotein and F-FDG standard uptake value predict tumor recurrence after liver transplantation for hepatocellular carcinoma with portal vein tumor thrombosis: Preliminary experience.

机构信息

Department of Hepatobiliary and Pancreatic Surgery, Department of Liver Transplantation, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou, China; Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; National Clinical Research Center of Infectious Diseases, Hangzhou, China.

Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.

出版信息

Hepatobiliary Pancreat Dis Int. 2020 Jun;19(3):229-234. doi: 10.1016/j.hbpd.2020.03.009. Epub 2020 Apr 8.

DOI:10.1016/j.hbpd.2020.03.009

PMID:32303439

Abstract

BACKGROUND

Portal vein tumor thrombosis (PVTT) is regarded as a contraindication for liver transplantation (LT) in hepatocellular carcinoma (HCC). However, some of these patients may have a favorable prognosis after LT. In this study, we evaluated the biological behavior of HCC with PVTT using tumor biomarker (alpha-fetoprotein, AFP) and F-FDG positron emission tomography (tumor standard uptake value) to identify a subset of patients who may be suitable for LT.

METHODS

Seventy-five HCC-PVTT liver recipients transplanted during February 2016 and June 2018 were analyzed. Different pre-transplant prognostic factors were identified by univariate and multivariate analyses. PVTT status was identified following Vp classification (Vp1-Vp4).

RESULTS

Three-year recurrence-free survival and overall survival rates were 40% and 65.4% in Vp2-Vp3 PVTT patients, 21.4% and 30.6% in Vp4 PVTT patients (P < 0.05). Total tumor diameter >8 cm, pre-transplant AFP level >1000 ng/mL and intrahepatic tumor maximal standard uptake value (SUVmax-tumor >5) were independent risk factors for HCC recurrence and overall survival after LT in Vp2-3 PVTT patients. Low risk patients were defined as total tumor diameter ≤8 cm; or if total tumor diameter more than 8 cm, with both pre-transplant AFP level less than 1000 ng/mL and intrahepatic tumor SUVmax less than 5, simultaneously. Twenty-two Vp2-3 PVTT HCC patients (46.8%) were identified as low risk patients, and their 3-year recurrence-free and overall survival rates were 67.6% and 95.2%, respectively.

CONCLUSIONS

Patients with segmental or lobar PVTT and biologically favorable tumors defined by AFP and F-FDG SUVmax might be suitable for LT.

摘要

背景

门静脉癌栓（PVTT）被认为是肝细胞癌（HCC）肝移植（LT）的禁忌证。然而，这些患者中的一些在 LT 后可能有良好的预后。在这项研究中，我们使用肿瘤标志物（甲胎蛋白，AFP）和 F-FDG 正电子发射断层扫描（肿瘤标准摄取值）评估了伴有 PVTT 的 HCC 的生物学行为，以确定可能适合 LT 的患者亚组。

方法

分析了 2016 年 2 月至 2018 年 6 月期间接受 75 例 HCC-PVTT 肝脏移植的患者。通过单变量和多变量分析确定了不同的移植前预后因素。根据 Vp 分类（Vp1-Vp4）确定 PVTT 状态。

结果

Vp2-Vp3 PVTT 患者的 3 年无复发生存率和总生存率分别为 40%和 65.4%，Vp4 PVTT 患者分别为 21.4%和 30.6%（P<0.05）。总肿瘤直径>8cm、移植前 AFP 水平>1000ng/ml 和肝内肿瘤最大标准摄取值（SUVmax-tumor>5）是 Vp2-3 PVTT 患者 LT 后 HCC 复发和总生存率的独立危险因素。低危患者定义为总肿瘤直径≤8cm；或如果总肿瘤直径大于 8cm，则同时满足移植前 AFP 水平<1000ng/ml 和肝内肿瘤 SUVmax<5。22 例 Vp2-3 PVTT HCC 患者（46.8%）被确定为低危患者，其 3 年无复发生存率和总生存率分别为 67.6%和 95.2%。