Total tumor volume predicts risk of recurrence following liver transplantation in patients with hepatocellular carcinoma
Total tumor volume predicts risk of recurrence following liver transplantation in patients with hepatocellular carcinoma
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DOI：
10.1002/lt.21484
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发表时间：
2008-08-01
影响因子：
4.6
通讯作者：
Kneteman, Norman M.
中科院分区：
文献类型：
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作者：
Toso, Christian;Trotter, James;Kneteman, Norman M.
在肝细胞癌（HCC）患者中选择肝移植候选人的标准应准确预测移植后复发，同时不排除过多患者的候选人资格。现有的标准受到放射性评估准确性有限的挑战。总肿瘤体积（TTV）通过将每个个体肿瘤的体积相加来计算。对来自阿尔伯塔肝移植项目（52例患者）的HCC患者数据进行了初步分析，然后对多伦多大学和科罗拉多大学项目（154例和82例患者）的人群进行了验证。根据使用受试者工作特征曲线的复发风险，选择TTV临界值115 cm（3）。与米兰和弗朗西斯科加州大学（UCSF）标准相比，TTV的放射学与病理学的相关性更密切（91%对69%和75%的患者，P < 0.0001）。虽然更多的患者符合TTV移植的合格标准（比米兰多28%-53%，比UCSF多16%-26%），但在阿尔伯塔和科罗拉多系列中，对TTV <115 cm（3）的患者进行的分析显示，结果没有恶化，复发率更高，患者生存率更低（P < 0.05）。当TTV以115 cm（3）为临界值用于候选者选择时，移植前放射学评估的准确性得到提高，尽管患者人群更具包容性，但移植后结局与Milan和UCSF分类的结果没有差异。
Criteria for the selection of candidates for liver transplantation in the presence of hepatocellular carcinoma (HCC) should accurately predict posttransplant recurrence while not excluding excessive numbers of patients from candidacy. Existing criteria are challenged by the limited accuracy of radiological assessment. The total tumor volume (TTV) was calculated by the addition of the volume of each individual tumor. A preliminary analysis was carried out on HCC patient data from the Alberta Liver Transplant Program (52 patients) and then validated on the populations of the Universities of Toronto and Colorado programs (154 and 82 patients). A TTV cutoff of 115 cm(3) was chosen on the basis of the risk of recurrence with use of a receiver operating characteristic curve. Radiology correlated more closely to pathology with TTV than with Milan and University of California at San Francisco (UCSF) criteria (91% versus 69% and 75% of patients, P < 0.0001). Although more patients met qualifying criteria for transplant with TTV (28%-53% more than Milan and 16%-26% more than UCSF), no deterioration of outcome was demonstrated in an analysis of patients within TTV 115 cm(3) experienced more recurrences and lower patient survival in the Alberta and Colorado series (P < 0.05). When TTV with a cutoff of 115 cm(3) is used for candidate selection, the accuracy of pretransplant radiological assessment is enhanced, with posttransplant outcomes not different from those achieved with Milan and UCSF classifications despite a more inclusive patient population.