Preoperative alpha-fetoprotein slope is predictive of hepatocellular carcinoma recurrence after liver transplantation
Preoperative alpha-fetoprotein slope is predictive of hepatocellular carcinoma recurrence after liver transplantation
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DOI：
10.1155/2007/206383
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发表时间：
2007-01-01
期刊：
影响因子：
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通讯作者：
Deschenes, Marc
中科院分区：
文献类型：
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作者：
Han, Kathy;Tzimas, George N.;Deschenes, Marc
背景：肝移植为肝细胞癌和肝硬化患者的治疗提供了可能。然而，在等待名单上的肿瘤进展和LT后的肿瘤复发是常见的。研究了各种术前和术后变量对肿瘤复发的预后意义，重点是术前血清甲胎蛋白（AFP）水平的斜率。来自48名术前诊断为HCC并在麦吉尔大学健康中心接受LT的患者的数据（蒙特利尔，魁北克）进行回顾性分析，并检查肿瘤复发的可能危险因素。单因素分析显示术前AFP斜率与血管侵犯呈正相关（P=0.045）、取出时的总分叉直径（P=0.040）、肝癌意大利项目评分（P=0.017）和无复发生存率（P=0.028）。在检查的术前变量中，只有术前AFP斜率通过多变量分析被确定为肿瘤复发的独立预测因子。恢复操作特征分析表明，最佳判别临界值，计算为最大似然比的值，术前AFP斜率大于50 μ g/L每月。在此临界值下，灵敏度为36%，特异性为97%。术前AFP斜率大于50 μ g/L/月的患者的1年无复发生存率比术前AFP斜率小于或等于50 μ g/L/月的患者低得多（40%对90%，P
BACKGROUND: Liver transplantation (LT) offers it possible cure for patients with hepatocellular carcinoma (HCC) and cirrhosis. However, tumour progression while on the waiting list and tumour recurrence after LT are common. The prognostic significance of various pre- and postoperative variables were investigated in regard to tumour recurrence, With an emphasis on the slope of preoperative serum alpha-fetoprotein (AFP) levels.PATIENTS AND METHODS: Data from 48 patients who had HCC diagnosed preoperatively and underwent LT at the McGill University Health Centre (Montreal, Quebec) were reviewed retrospectively, and possible risk factors for tumour recurrence were examined.RESULTS: Univariate analysis revealed a positive correlation between the preoperative AFP slope and vascular invasion (P=0.045), total turnout diameter at explant (P=0.040), Cancer of the Liver Italian Program score (P=0.017) and recurrence-free survival (P=0.028). Of the preoperative variables examined, only the preoperative AFP slope was identified as an Independent predictor of tumour recurrence by multivariate analysis. Recover operating characteristic analysis showed that the best discriminant cut-off value, calculated as the value of the maximized likelihood ratio, was preoperative AFP slope greater than 50 mu g/L per month. At this cut-off, sensitivity was 36%, and specificity was 97%. Patients with a preoperative AFP slope greater than 50 mu g/L per month had a much worse one-year recurrence-free survival rate than those with a preoperative AFP slope 50 mu g/L per month or less (40% versus 90%, P