Incorporating Tumor Biology to Predict Hepatocellular Carcinoma Recurrence in Patients Undergoing Living Donor Liver Transplantation Using Expanded Selection Criteria
Incorporating Tumor Biology to Predict Hepatocellular Carcinoma Recurrence in Patients Undergoing Living Donor Liver Transplantation Using Expanded Selection Criteria
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DOI：
10.1002/lt.25956
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发表时间：
2021-01-29
影响因子：
4.6
通讯作者：
Soin, A. S.
中科院分区：
文献类型：
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作者：
Bhangui, Prashant;Saigal, Sanjiv;Soin, A. S.
肝细胞癌（HCC）患者肝移植（LT）的传统选择标准仅基于肿瘤大小/数量，并且不考虑肿瘤生物学的重要替代指标，例如甲胎蛋白（AFP）和肿瘤[F-18]氟脱氧葡萄糖正电子发射断层扫描（[F-18]FDG PET）亲合力。我们使用我们扩展的选择标准，分析了 405 名接受活体供体 LT (LDLT) 的肝硬化和 HCC (HCC-cirr) 患者的生存结果和 HCC 复发的预测因素：无论肿瘤大小/数量如何，均无肝外疾病或主要血管侵犯。 51% 的患者肿瘤超出米兰范围，43% 的患者肿瘤超出加州大学旧金山分校 [UCSF] 标准。 5年总生存率（OS）和无复发生存率（RFS）分别为64%和70%。三个术前可用因素可预测复发：LT前AFP >= 100 ng/mL（P = 0.005；风险比[HR]，2.190）、超出UCSF标准的肿瘤负荷（P = 0.001；HR，2.640）和[F-18]FDG PET亲和力（P = 0.004；HR，2.442）。使用竞争风险 RFS 模型开发了基于上述术前风险因素的数量和组合的预后模型。确定了三个风险组：低（不存在或存在单一危险因素，9.3% 复发）、中度（AFP >= 100 ng/mL 和 [F-18]FDG PET 亲和力，或超出 UCSF 肿瘤和 [F-18]FDG PET 亲和力，25% 复发）和高（AFP >= 100 ng/mL 并超出 UCSF，或存在所有 3 个危险因素，46%复发）。使用我们扩大的选择标准实现了可接受的长期结果。我们基于术前生物学和形态学因素预测复发的预后模型可以指导移植前管理（降期与前期 LDLT），以减少 LDLT 后复发。
Conventional selection criteria for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) are based on tumour size/number only, and do not consider vital surrogates of tumor biology such as alpha-fetoprotein (AFP) and tumor [F-18]fluorodeoxyglucose positron emission tomography ([F-18]FDG PET) avidity. We analyzed survival outcomes, and predictors of HCC recurrence in 405 patients with cirrhosis and HCC (HCC-cirr) who underwent living donor LT (LDLT) using our expanded selection criteria: no extrahepatic disease or major vascular invasion, irrespective of tumor size/number. Fifty-one percent patients had tumours beyond Milan, and 43% beyond the University of California San Francisco [UCSF] criteria. The 5-year overall survival (OS) and recurrence-free survival (RFS) were 64% and 70%, respectively. Three preoperatively available factors predicted recurrence: pre-LT AFP >= 100 ng/mL (P = 0.005; hazard ratio [HR], 2.190), tumor burden beyond the UCSF criteria (P = 0.001; HR, 2.640), and [F-18]FDG PET avidity (P = 0.004; HR, 2.442). A prognostic model based on the number and combination of the aforementioned preoperative risk factors was developed using a competing-risk RFS model. Three risk groups were identified: low (none or a single risk factor present, 9.3% recurrence), moderate (AFP >= 100 ng/mL and [F-18]FDG PET avidity, or beyond UCSF tumor and [F-18]FDG PET avidity, 25% recurrence), and high (AFP >= 100 ng/mL and beyond UCSF, or presence of all 3 risk factors, 46% recurrence). Acceptable long-term outcomes were achieved using our expanded selection criteria. Our prognostic model to predict recurrence based on preoperative biological and morphological factors could guide pretransplant management (downstaging versus upfront LDLT) with the aim of reducing post-LDLT recurrence.