Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ 85054, USA.
Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
Curr Oncol. 2022 Oct 8;29(10):7537-7551. doi: 10.3390/curroncol29100593.
Hepatocellular carcinoma (HCC) is one of the leading indications for liver transplantation and has been the treatment of choice due to the oncologic benefit for patients with advanced chronic liver disease (AdvCLD) and small tumors for the last 25 years. For HCC patients undergoing liver transplantation, alpha fetoprotein (AFP) has increasingly been applied as an independent predictor for overall survival, disease free recurrence, and waitlist drop out. In addition to static AFP, newer studies evaluating the AFP dynamic response to downstaging therapy show enhanced prognostication compared to static AFP alone. While AFP has been utilized to select HCC patients for transplant, despite years of allocation policy changes, the US allocation system continues to take a uniform approach to HCC patients, without discriminating between those with favorable or unfavorable tumor biology. We aim to review the history of liver allocation for HCC in the US, the utility of AFP in liver transplantation, the implications of weaving AFP as a biomarker into policy. Based on this review, we encourage the US transplant community to revisit its HCC organ allocation model, to incorporate more precise oncologic principles for patient selection, and to adopt AFP dynamics to better stratify waitlist dropout risk.
肝细胞癌（HCC）是肝移植的主要适应证之一，由于其对晚期慢性肝病（AdvCLD）和小肿瘤患者具有肿瘤学益处，因此在过去 25 年中一直是首选治疗方法。对于接受肝移植的 HCC 患者，甲胎蛋白（AFP）越来越多地被用作总生存、无疾病复发和等待名单淘汰的独立预测因子。除了静态 AFP 外，评估 AFP 对降期治疗的动态反应的新研究表明，与单独使用静态 AFP 相比，具有更好的预后预测能力。尽管 AFP 已被用于选择接受移植的 HCC 患者，但尽管分配政策多年来发生了变化，美国的分配系统仍继续对 HCC 患者采取统一的方法，而不区分肿瘤生物学有利或不利的患者。我们旨在回顾美国 HCC 肝分配的历史、AFP 在肝移植中的应用、将 AFP 编织为生物标志物纳入政策的意义。基于这一回顾，我们鼓励美国移植界重新审视其 HCC 器官分配模型，以纳入更精确的肿瘤学患者选择原则，并采用 AFP 动力学更好地分层等待名单淘汰风险。
