Predicting Mortality in Patients Developing Recurrent Hepatocellular Carcinoma After Liver Transplantation Impact of Treatment Modality and Recurrence Characteristics
Predicting Mortality in Patients Developing Recurrent Hepatocellular Carcinoma After Liver Transplantation Impact of Treatment Modality and Recurrence Characteristics
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DOI：
10.1097/sla.0000000000001894
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发表时间：
2017-07-01
影响因子：
9
通讯作者：
Agopian, Vatche G.
中科院分区：
文献类型：
--
作者：
Bodzin, Adam S.;Lunsford, Keri E.;Agopian, Vatche G.
目的：评价肝移植术后复发患者死亡率的预测因素和治疗的影响。背景资料摘要：尽管对肝细胞癌术后复发的临床病理预测因素已有很好的描述，但有关术后复发预后的数据却很少。方法：通过建立危险评分模型，对1984年至2014年间106例肝细胞癌术后复发患者的预后亚组进行分层，包括复发治疗方式对生存的影响。结果：在857例接受肝移植术后复发的患者中，106例(12.4%)发生肝移植后肝细胞癌复发(肝移植后中位数15.8个月)，中位复发后生存10.6个月。接受手术治疗的患者(n=25)的中位生存期为27.8个月，显著优于接受非手术治疗的患者(10.6个月)和最佳支持治疗的患者(3.7月，P<；0.001)。复发后死亡率的多变量预测因素包括23个终末期肝病的模型、复发时间、3个复发结节、最大复发大小、骨复发、复发时甲胎蛋白、供者血钠和移植前受者中性粒细胞/淋巴细胞比率。一个基于多变量预测因子的风险评分模型准确地将复发肝癌患者分成预后亚组，其中低风险患者(10分)显示良好的中位生存期为70.6个月，显著优于中危患者(12.2月，10-16个月)和高危患者(3.4月，P<；0.001)(C-统计量0.75，P<；0.001)。结论：在肝移植术后复发肝癌的最大单中心报告中，精心选择的患者的手术治疗与显著改善生存有关，值得继续研究。风险评分模型准确地对预后亚组进行分层，可能有助于指导治疗策略。
Objective: To evaluate predictors of mortality and impact of treatment in patients developing recurrent hepatocellular carcinoma (HCC) following liver transplantation (LT).Summary of Background Data: Despite well-described clinicopathologic predictors of posttransplant HCC recurrence, data on prognosis following recurrence are scarce.Methods: Multivariate predictors of mortality following HCC recurrence were identified to develop a risk score model to stratify prognostic subgroups among 106 patients developing posttransplant recurrence from 1984 to 2014, including analysis of recurrence treatment modality on survival.Results: Of 857 patients undergoing LT, 106 (12.4%) developed posttransplant HCC recurrence (median 15.8 months following LT) with a median post-recurrence survival of 10.6 months. Patients receiving surgical therapy (n = 25) had a median survival of 27.8 months, significantly superior to patients receiving nonsurgical therapy (10.6 months) and best supportive care (3.7 months, P < 0.001). Multivariate predictors of mortality following recurrence included model for end-stage liver disease at LT > 23, time to recurrence, > 3 recurrent nodules, maximum recurrence size, bone recurrence, alphafetoprotein at recurrence, donor serum sodium, and pretransplant recipient neutrophil-lymphocyte ratio. A risk score model based on multivariate predictors accurately stratified recurrent HCC patients into prognostic subgroups, with low-risk patients (< 10 points) demonstrating excellent median survival of 70.6 months, significantly superior to the medium-risk (12.2 months, 10-16 points) and high-risk (3.4 months, >16 points) groups (C-statistic 0.75, P < 0.001).Conclusions: In the largest single-center report of recurrent HCC following LT, surgical treatment in well-selected patients is associated with significantly improved survival and should be pursued. A risk score model accurately stratifies prognostic subgroups, and may help guide treatment strategies.