Aujla Usman I, Syed Imran Ali, Rafi Kashif, Naveed Ammara, Malik Ahmad K, Khan Muhammad Yasir, Haq Ihsan Ul, Rashid Sohail, Butt Osama T, Dar Faisal
Gastroenterology and Hepatology, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK.
Gastroenterology, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK.
Cureus. 2024 Dec 2;16(12):e75007. doi: 10.7759/cureus.75007. eCollection 2024 Dec.
Among primary liver tumors, hepatocellular carcinoma (HCC) is considered the most common hepatic tumor. Liver transplantation is one of the curative treatment options for HCC. However, the risk of HCC recurrence after liver transplantation varies and is influenced by various factors. Microvascular invasion (MVI) is a major factor associated with HCC recurrence after a liver transplant (LT). The study assessed the pre-transplant factors to predict MVI on explant liver specimens.
The retrospective study included adult LT recipients with HCC on explant specimens to identify pre-transplant predictors of MVI. Univariate analyses, including Mann-Whitney U tests and chi-square tests, were conducted to assess associations between variables and MVI. Logistic regression was employed for multivariate analysis, including variables significant in univariate analysis. Pearson or Spearman correlation coefficients were calculated to examine correlations between continuous variables. Cohen's kappa coefficient was used to measure inter-rater reliability.
Out of 523 LT recipients, 136 (26%) were diagnosed with HCC based on pre-transplant imaging and histopathological analysis of the explanted liver. Descriptive data showed an average age of 54.06 ± 8.16 years (range: 15-70), with a majority being male (76.47%). Hepatitis C (HCV) was the leading etiology (72.8%). Most patients had moderately differentiated grade-II tumors (75.7%) and met the Milan criteria (74.3%). Mean pre-operative alpha-fetoprotein (pre-op AFP) levels were 104.42 ± 308.38 ng/ml. 74.3% were within the Milan criteria. MVI was present in 28.7%. The frequency of MVI among HCCs within vs. outside Milan criteria was not statistically significant (26.73% vs. 34.28% (p = 0.395)). Univariate analysis revealed that pre-op AFP levels (p = 0.001), Child-Turcotte Pugh class (p=0.05), and body mass index (p=0.02) were significantly associated with MVI. Multivariate logistic regression analysis showed that pre-op AFP was the only independent predictor of MVI (OR: 1.006, 95% CI: 1.003-1.008, p < 0.001).
This study not only reinforces the clinical significance of pre-op AFP levels as a simple pre-transplant predictor of MVI in patients with HCC but also advocates for the safety of liver transplantation beyond conventional Milan criteria, promoting extended LT protocols.
在原发性肝肿瘤中，肝细胞癌（HCC）被认为是最常见的肝肿瘤。肝移植是HCC的治愈性治疗选择之一。然而，肝移植后HCC复发的风险各不相同，且受多种因素影响。微血管侵犯（MVI）是肝移植（LT）后与HCC复发相关的主要因素。本研究评估了移植前因素以预测移植肝标本中的MVI。
这项回顾性研究纳入了接受LT的成年HCC患者的移植标本，以确定移植前MVI的预测因素。进行了单因素分析，包括Mann-Whitney U检验和卡方检验，以评估变量与MVI之间的关联。采用逻辑回归进行多因素分析，包括在单因素分析中有显著意义的变量。计算Pearson或Spearman相关系数以检验连续变量之间的相关性。使用Cohen's kappa系数来衡量评分者间的可靠性。
在523例LT受者中，136例（26%）根据移植前影像学检查和移植肝的组织病理学分析被诊断为HCC。描述性数据显示平均年龄为54.06±8.16岁（范围：15 - 70岁），大多数为男性（76.47%）。丙型肝炎（HCV）是主要病因（72.8%）。大多数患者患有中度分化的II级肿瘤（75.7%）且符合米兰标准（74.3%）。术前甲胎蛋白（术前AFP）平均水平为104.42±308.38 ng/ml。74.3%符合米兰标准。MVI存在于28.7%的患者中。米兰标准内与标准外的HCC中MVI的发生率无统计学差异（26.73%对34.28%（p = 0.395））。单因素分析显示术前AFP水平（p = 0.001）、Child-Turcotte Pugh分级（p = 0.05）和体重指数（p = 0.02）与MVI显著相关。多因素逻辑回归分析显示术前AFP是MVI的唯一独立预测因素（OR：1.006，95%CI：1.003 - 1.008，p < 0.001）。
本研究不仅强化了术前AFP水平作为HCC患者移植前MVI简单预测指标的临床意义，还倡导超越传统米兰标准进行肝移植的安全性，推动扩大LT方案。
