非酒精性脂肪性肝病相关肝癌肝移植受者的预后：美国多中心肝癌移植联盟的结果
Outcomes in liver transplant recipients with nonalcoholic fatty liver disease-related HCC: results from the US multicenter HCC transplant consortium.
作者信息
Verna Elizabeth C, Phipps Meaghan M, Halazun Karim J, Markovic Daniela, Florman Sander S, Haydel Brandy M, Ruiz Richard, Klintmalm Goran, Lee David D, Taner Burcin, Hoteit Maarouf A, Tevar Amit D, Humar Abhinav, Chapman William C, Vachharajani Neeta, Aucejo Federico N, Melcher Marc L, Nguyen Mindie H, Nydam Trevor L, Markmann James F, Mobley Constance, Ghobrial Rafik M, Langnas Alan N, Berumen Jennifer, Schnickel Gabriel T, Sudan Debra, Hong Johnny C, Rana Abbas, Jones Christopher M, Fishbein Thomas M, Busuttil Ronald W, Agopian Vatche
机构信息
Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, New York, USA.
Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Weill Cornell Medicine, New York, New York, USA.
出版信息
Liver Transpl. 2023 Jan 1;29(1):34-47. doi: 10.1097/LVT.0000000000000007. Epub 2022 Dec 23.
NAFLD will soon be the most common indication for liver transplantation (LT). In NAFLD, HCC may occur at earlier stages of fibrosis and present with more advanced tumor stage, raising concern for aggressive disease. Thus, adult LT recipients with HCC from 20 US centers transplanted between 2002 and 2013 were analyzed to determine whether NAFLD impacts recurrence-free post-LT survival. Five hundred and thirty-eight (10.8%) of 4981 total patients had NAFLD. Patients with NAFLD were significantly older (63 vs. 58, p<0.001), had higher body mass index (30.5 vs. 27.4, p<0.001), and were more likely to have diabetes (57.3% vs. 28.8%, p<0.001). Patients with NAFLD were less likely to receive pre-LT locoregional therapy (63.6% vs. 72.9%, p<0.001), had higher median lab MELD (15 vs. 13, p<0.001) and neutrophil-lymphocyte ratio (3.8 vs. 2.9, p<0.001), and were more likely to have their maximum pre-LT alpha fetoprotein at time of LT (44.1% vs. 36.1%, p<0.001). NAFLD patients were more likely to have an incidental HCC on explant (19.4% vs. 10.4%, p<0.001); however, explant characteristics including tumor differentiation and vascular invasion were not different between groups. Comparing NAFLD and non-NAFLD patients, the 1, 3, and 5-year cumulative incidence of recurrence (3.1%, 9.1%, 11.5% vs. 4.9%, 10.1%, 12.6%, p=0.36) and recurrence-free survival rates (87%, 76%, and 67% vs. 87%, 75%, and 67%, p=0.97) were not different. In competing risks analysis, NAFLD did not significantly impact recurrence in univariable (HR: 0.88, p=0.36) nor in adjusted analysis (HR: 0.91, p=0.49). With NAFLD among the most common causes of HCC and poised to become the leading indication for LT, a better understanding of disease-specific models to predict recurrence is needed. In this NAFLD cohort, incidental HCCs were common, raising concerns about early detection. However, despite less locoregional therapy and high neutrophil-lymphocyte ratio, explant tumor characteristics and post-transplant recurrence-free survival were not different compared to non-NAFLD patients.
非酒精性脂肪性肝病（NAFLD）很快将成为肝移植（LT）最常见的适应证。在NAFLD中，肝细胞癌（HCC）可能在纤维化的早期阶段发生，且肿瘤分期更晚，这引发了对侵袭性疾病的担忧。因此，对2002年至2013年间在美国20个中心接受移植的成年HCC肝移植受者进行分析，以确定NAFLD是否会影响肝移植后的无复发生存率。在4981例患者中，538例（10.8%）患有NAFLD。患有NAFLD的患者年龄显著更大（63岁对58岁，p<0.001），体重指数更高（30.5对27.4，p<0.001），且更有可能患有糖尿病（57.3%对28.8%，p<0.001）。患有NAFLD的患者接受肝移植前局部区域治疗的可能性较小（63.6%对72.9%，p<0.001），实验室中位终末期肝病模型（MELD）评分更高（15对13，p<0.001），中性粒细胞与淋巴细胞比值更高（3.8对2.9，p<0.001），且在肝移植时其肝移植前甲胎蛋白最高值的可能性更大（44.1%对36.1%，p<0.001）。NAFLD患者肝移植时意外发现HCC的可能性更大（19.4%对10.4%，p<0.001）；然而，包括肿瘤分化和血管侵犯在内的肝移植标本特征在两组之间并无差异。比较NAFLD患者和非NAFLD患者，复发的1年、3年和5年累积发生率（3.1%、9.1%、11.5%对4.9%、10.1%、12.6%，p= .36）和无复发生存率（87%、76%和67%对87%、75%和67%，p= .97）并无差异。在竞争风险分析中，NAFLD在单变量分析中对复发无显著影响（风险比：0.88，p= .36），在多变量分析中也无显著影响（风险比：0.91，p= .49）。鉴于NAFLD是HCC最常见的病因之一，并有望成为肝移植的主要适应证，需要更好地了解预测复发的疾病特异性模型。在这个NAFLD队列中，意外发现的HCC很常见，这引发了对早期检测问题的关注。然而，尽管局部区域治疗较少且中性粒细胞与淋巴细胞比值较高，但与非NAFLD患者相比，肝移植标本肿瘤特征和移植后无复发生存率并无差异。
Zotero 插件