Núñez Kelley G, Sandow Tyler, Patel Jai, Hibino Mina, Fort Daniel, Cohen Ari J, Thevenot Paul
Institute of Translational Research, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
Department of Radiology, Ochsner Health, New Orleans, LA 70121, USA.
Cancers (Basel). 2022 Mar 25;14(7):1684. doi: 10.3390/cancers14071684.
Due to active hepatocellular carcinoma (HCC) surveillance, many patients are diagnosed with early-stage disease and are usually amendable to curative treatments. These patients lack poor prognostic factors associated with Milan Criteria and alpha fetoprotein (AFP) biomarker levels. There are currently limited strategies to assess prognosis in the patients who remain at risk of post-treatment HCC progression. In a cohort of liver transplant (LT) candidates with HCC, this study seeks to identify factors prior to liver-directed therapy (LDT) associated with time to progression (TTP). This is a retrospective analysis of prospectively collected data from LT candidates with recently diagnosed HCC and receiving LDT as a bridge to LT at three interventional oncology programs within a single system (n = 373). Demographics, clinical hepatology and serology, and factors related to HCC burden were extracted and analyzed for associations with TTP risk. Albumin level below the cohort median (3.4 g/dL) emerged as an independent risk factor for TTP controlling for AFP > 20 ng/mL as well as Milan, T-stage, and Barcelona Clinic Liver Cancer (BCLC) stage individually. In modality-specific subgroup survival analysis, albumin-based TTP stratification was restricted to patients receiving first cycle microwave ablation (p = 0.007). In n = 162 patients matching all low-risk criteria for Milan, T-stage, BCLC stage, and AFP, the effect of albumin < 3.4 g/dL remained significant for TTP (p = 0.004) with 2-year TTP rates of 68% (<3.4 g/dL) compared to 95% (≥3.4 g/dL). In optimal bridge to LT candidates with small HCC and low AFP biomarker levels, albumin level at treatment baseline provides an HCC-independent positive prognostic factor for risk of HCC progression prior to LT.
由于肝细胞癌（HCC）的积极监测，许多患者被诊断为早期疾病，通常适合进行根治性治疗。这些患者缺乏与米兰标准和甲胎蛋白（AFP）生物标志物水平相关的不良预后因素。目前，评估仍有治疗后HCC进展风险的患者预后的策略有限。在一组HCC肝移植（LT）候选者中，本研究旨在确定肝导向治疗（LDT）前与进展时间（TTP）相关的因素。这是一项对前瞻性收集的数据进行的回顾性分析，这些数据来自一个系统内三个介入肿瘤项目中最近诊断为HCC并接受LDT作为LT过渡治疗的LT候选者（n = 373）。提取并分析了人口统计学、临床肝病学和血清学以及与HCC负担相关的因素，以确定其与TTP风险的关联。白蛋白水平低于队列中位数（3.4 g/dL）成为TTP的独立危险因素，分别控制AFP>20 ng/mL以及米兰、T分期和巴塞罗那临床肝癌（BCLC）分期。在特定方式的亚组生存分析中，基于白蛋白的TTP分层仅限于接受第一周期微波消融的患者（p = 0.007）。在162例符合米兰、T分期、BCLC分期和AFP所有低风险标准的患者中，白蛋白<3.4 g/dL对TTP的影响仍然显著（p = 0.004），2年TTP率为68%（<3.4 g/dL），而≥3.4 g/dL时为95%。在具有小HCC和低AFP生物标志物水平的LT最佳过渡候选者中，治疗基线时的白蛋白水平为LT前HCC进展风险提供了一个独立于HCC的阳性预后因素。
