Lu Di, Yang Fan, Zhuo Jianyong, Yang Modan, Lin Zuyuan, Jin Pingbo, Cai Xuechun, Cen Beini, Wang Jianguo, Wei Xuyong, Zheng Shusen, Xu Xiao
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China.
Clin Transl Gastroenterol. 2020 May;11(5):e00168. doi: 10.14309/ctg.0000000000000168.
Antibody to hepatitis B core antigen (HBcAb) is known to be related with the prognosis for patients with hepatocellular carcinoma (HCC). This study aims to evaluate the prognostic capacity of HbcAb and other donor/recipient hepatitis B seroepidemiological indexes in transplantation for HCC.
Based on the national liver transplant registry, we analyzed the prognostic capacity of HBcAb in liver transplantation for patients with HCC of different etiological backgrounds. The hepatitis B virus (HBV)-related HCC cohort was further studied regarding donor/recipient hepatitis B seroepidemiology, and then divided into a training cohort (n = 1,222) and a validation cohort (n = 611) to develop a pretransplant recurrence-risk predicting nomogram.
Positive HbcAb in recipients was related to an increased risk of post-transplant tumor recurrence in HBV-related (n = 1,833, P = 0.007), HCV-related (n = 79, P = 0.037), and non-B non-C HCC (n = 313, P = 0.017). In HBV-related HCC (n = 1,833), donor hepatitis B surface antigen (HbsAg) was also associated with post-transplant tumor recurrence (P = 0.020). Multivariate analysis showed that the matching status of recipient HbcAb and donor HbsAg (MSHB) was an independent prognostic factor (P = 0.017). HbcAb-positive recipients matched with HbsAg-positive donors displayed the worst post-transplant outcomes (P < 0.001). In the training cohort (n = 1,222), a risk-predicting nomogram was established based on α-fetoprotein, Milan criteria, and MSHB. The model showed excellent prognostic capacity and safely expanded Milan criteria in both training and validation cohorts (P < 0.001).
Positive HbcAb in recipients increases the risk of post-transplant tumor recurrence in HCC with different etiological backgrounds. The nomogram based on MSHB is effective in predicting tumor recurrence after transplantation for HBV-related HCC.
已知乙肝核心抗原抗体（HBcAb）与肝细胞癌（HCC）患者的预后相关。本研究旨在评估HBcAb及其他供体/受体乙肝血清流行病学指标在HCC肝移植中的预后能力。
基于国家肝移植登记处，我们分析了HBcAb在不同病因背景的HCC患者肝移植中的预后能力。对乙肝病毒（HBV）相关HCC队列进一步研究供体/受体乙肝血清流行病学，然后分为训练队列（n = 1222）和验证队列（n = 611），以建立移植前复发风险预测列线图。
受体HBcAb阳性与HBV相关（n = 1833，P = 0.007）、HCV相关（n = 79，P = 0.037）和非B非C型HCC（n = 313，P = 0.017）患者移植后肿瘤复发风险增加相关。在HBV相关HCC（n = 1833）中，供体乙肝表面抗原（HbsAg）也与移植后肿瘤复发相关（P = 0.020）。多变量分析显示，受体HBcAb与供体HbsAg的匹配状态（MSHB）是独立的预后因素（P = 0.017）。HBcAb阳性受体与HbsAg阳性供体匹配时，移植后结局最差（P < 0.001）。在训练队列（n = 1222）中，基于甲胎蛋白、米兰标准和MSHB建立了风险预测列线图。该模型在训练和验证队列中均显示出优异的预后能力，并安全地扩展了米兰标准（P < 0.001）。
受体HBcAb阳性会增加不同病因背景的HCC患者移植后肿瘤复发风险。基于MSHB的列线图可有效预测HBV相关HCC移植后肿瘤复发。
