改良 AFP 模型对多结节性肝细胞癌患者肝移植结局的预测价值。

The predictive value of the modified AFP model for liver transplantation outcomes in multinodular hepatocellular carcinoma patients.

机构信息

Department of Hepatobiliary and Pancreatic Surgery, The Center for Integrated Oncology and Precision Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China.

Zhejiang University School of Medicine, Hangzhou, 310006, China.

出版信息

World J Surg Oncol. 2023 Mar 27;21(1):104. doi: 10.1186/s12957-023-02994-y.

DOI:10.1186/s12957-023-02994-y

PMID:36967432

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10041809/

Abstract

BACKGROUND

There is a lack of studies focusing on the benefit of liver transplantation (LT) in hepatocellular carcinoma (HCC) patients with > 3 tumors. This study aims to establish a model to effectively predict overall survival in Chinese HCC patients with multiple tumors (> 3 tumors) who undergo LT.

METHODS

This retrospective study included 434 HCC liver transplant recipients from the China Liver Transplant Registry. All HCC patients had more than 3 tumor nodules. Three selection criteria systems (i.e., AFP, Metroticket 2.0, and Up-to-7) were compared regarding the prediction of HCC recurrence. The modified AFP model was established by univariate and multivariate competing risk analyses.

RESULTS

The AFP score 2 and the AFP score ≥ 3 groups had 5-year recurrence rates of 19.6% and 40.5% in our cohort. The prediction of HCC recurrence based on the AFP model was associated with a c-statistic of 0.606, which was superior to the Up-to-7 and Metroticket 2.0 models. AFP level > 1000 ng/mL, largest tumor size ≥ 8 cm, vascular invasion, and MELD score ≥ 15 were associated with overall survival. The 5-year survival rate in the modified AFP score 0 group was 71.7%.

CONCLUSIONS

The AFP model is superior in predicting tumor recurrence in HCC patients with > 3 tumors prior to LT. With the modified AFP model, patients likely to derive sufficient benefit from LT can be identified.

摘要

背景

目前缺乏针对多肿瘤（>3 个肿瘤）肝细胞癌（HCC）患者行肝移植（LT）获益的研究。本研究旨在建立一种模型，以有效预测行 LT 的中国多肿瘤（>3 个肿瘤）HCC 患者的总生存率。

方法

本回顾性研究纳入了来自中国肝移植注册中心的 434 例 HCC 肝移植受者。所有 HCC 患者均有 3 个以上肿瘤结节。比较了 AFP、Metroticket 2.0 和 Up-to-7 三种选择标准系统在预测 HCC 复发方面的表现。采用单变量和多变量竞争风险分析建立改良 AFP 模型。

结果

在本队列中，AFP 评分 2 分和 AFP 评分≥3 分组的 5 年复发率分别为 19.6%和 40.5%。基于 AFP 模型的 HCC 复发预测与 c 统计量 0.606 相关，优于 Up-to-7 和 Metroticket 2.0 模型。AFP 水平>1000ng/mL、最大肿瘤直径≥8cm、血管侵犯和 MELD 评分≥15 与总生存相关。改良 AFP 评分 0 分组的 5 年生存率为 71.7%。