Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Zhejiang Provincial Key Laboratory of Pancreatic Disease, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
BMC Cancer. 2023 Jan 25;23(1):86. doi: 10.1186/s12885-023-10550-w.
Tumor micronecrosis is a histopathological feature predicting poor prognosis in patients with hepatocellular carcinoma (HCC) who underwent liver resection. However, the role of tumor micronecrosis in liver transplantation remains unclear.
We retrospectively reviewed patients with HCC who underwent liver transplantation between January 2015 and December 2021 at our center. We then classified them into micronecrosis(-) and micronecrosis(+) groups and compared their recurrence-free survival (RFS) and overall survival (OS). We identified independent prognostic factors using Cox regression analysis and calculated the area under the receiver operating characteristic curve (AUC) to evaluate the predictive value of RFS for patients with HCC after liver transplantation.
A total of 370 cases with evaluable histological sections were included. Patients of the micronecrosis(+) group had a significantly shorter RFS than those of the micronecrosis(-) group (P = 0.037). Shorter RFS and OS were observed in micronecrosis(+) patients without bridging treatments before liver transplantation (P = 0.002 and P = 0.007), while no differences were detected in those with preoperative antitumor therapies that could cause iatrogenic tumor necrosis. Tumor micronecrosis improved the AUC of Milan criteria (0.77-0.79), the model for end-stage liver disease score (0.70-0.76), and serum alpha-fetoprotein (0.63-0.71) for the prediction of prognosis after liver transplantation.
Patients with HCC with tumor micronecrosis suffer from a worse prognosis than those without this feature. Tumor micronecrosis can help predict RFS after liver transplantation. Therefore, patients with HCC with tumor micronecrosis should be treated with adjuvant therapy and closely followed after liver transplantation.
Not Applicable.
肿瘤微坏死是预测接受肝切除术的肝细胞癌（HCC）患者预后不良的组织病理学特征。然而，肿瘤微坏死在肝移植中的作用尚不清楚。
我们回顾性分析了 2015 年 1 月至 2021 年 12 月在我院接受肝移植的 HCC 患者。然后，我们将其分为微坏死（-）和微坏死（+）组，并比较了他们的无复发生存率（RFS）和总生存率（OS）。我们使用 Cox 回归分析确定独立的预后因素，并计算 ROC 曲线下的面积（AUC）来评估肿瘤微坏死对肝移植后 HCC 患者 RFS 的预测价值。
共纳入 370 例可评估的组织学切片。微坏死（+）组患者的 RFS 明显短于微坏死（-）组（P=0.037）。在未接受肝移植前桥接治疗的微坏死（+）患者中，RFS 和 OS 更短（P=0.002 和 P=0.007），而在接受术前抗肿瘤治疗（可能导致医源性肿瘤坏死）的患者中则没有差异。肿瘤微坏死提高了米兰标准（0.77-0.79）、终末期肝病模型评分（0.70-0.76）和血清甲胎蛋白（0.63-0.71）对肝移植后预后的预测能力。
肿瘤微坏死的 HCC 患者比无此特征的患者预后更差。肿瘤微坏死有助于预测肝移植后的 RFS。因此，有肿瘤微坏死的 HCC 患者应接受辅助治疗，并在肝移植后密切随访。
不适用。
