Gongor Saran Ochir, Choi YoungRok, Kim Gayoung, Kim Min Kyoung, Park Sang Hyuk, Kim Jiyoung, Kim Jae-Yoon, Hong Su Young, Lee Jeong-Moo, Hong Suk Kyun, Lee Kwang-Woong
Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
Transpl Int. 2025 Jun 27;38:14748. doi: 10.3389/ti.2025.14748. eCollection 2025.
Despite the development of numerous prognostic models for hepatocellular carcinoma (HCC) recurrence and mortality after liver transplantation, tumor biomarkers such as alpha-fetoprotein (AFP) and protein induced by vitamin K absence-II (PIVKA-II) remain widely used in clinical practice. This study evaluated the performance of AFP and PIVKA-II compared with six prognostic models (RETREAT, SNAPP, MoRAL, R3-AFP, METROTICKET 2.0, and SALT) in a retrospective cohort of 707 adults who underwent living donor liver transplantation (LDLT) for HCC between 2003 and 2018. Patients were stratified into Milan and Beyond Milan groups. Time-dependent receiver operating characteristic curve analysis was conducted using integrated area under the curve (iAUC) and concordance index (C-index) to assess recurrence and mortality. AFP and PIVKA-II (continuous) achieved iAUCs of 0.68-0.75 for recurrence and C-indices of 0.66-0.77 for mortality. Their combination reached iAUCs up to 0.78 and C-indices up to 0.80. Threshold models (AFP ≥200, PIVKA-II ≥400) showed modest predictive performance. Among multivariable models, R3-AFP demonstrated the most consistent performance (iAUC 0.76-0.81; C-index 0.78-0.82). SNAPP, MoRAL, and SALT also performed well. AFP and PIVKA-II may offer practical utility in resource-limited settings. However, multivariable models remain the preferred approach where comprehensive diagnostics are available.
尽管已经开发出许多用于预测肝细胞癌（HCC）肝移植后复发和死亡率的模型，但甲胎蛋白（AFP）和维生素K缺乏诱导蛋白-II（PIVKA-II）等肿瘤生物标志物在临床实践中仍被广泛使用。本研究在一项回顾性队列研究中，评估了AFP和PIVKA-II与六种预后模型（RETREAT、SNAPP、MoRAL、R3-AFP、METROTICKET 2.0和SALT）相比的性能，该队列研究纳入了2003年至2018年间因HCC接受活体肝移植（LDLT）的707名成年人。患者被分为米兰标准组和超出米兰标准组。使用曲线下综合面积（iAUC）和一致性指数（C指数）进行时间依赖性受试者工作特征曲线分析，以评估复发和死亡率。AFP和PIVKA-II（连续变量）复发的iAUC为0.68-0.75，死亡率的C指数为0.66-0.77。它们的联合使用iAUC高达0.78，C指数高达0.80。阈值模型（AFP≥200，PIVKA-II≥400）显示出适度的预测性能。在多变量模型中，R3-AFP表现出最一致的性能（iAUC 0.76-0.81；C指数0.78-0.82）。SNAPP、MoRAL和SALT也表现良好。AFP和PIVKA-II在资源有限的环境中可能具有实际用途。然而，在可进行全面诊断的情况下，多变量模型仍然是首选方法。
