Preoperative prognostic values of α-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) in patients with hepatocellular carcinoma for living donor liver transplantation
Preoperative prognostic values of α-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) in patients with hepatocellular carcinoma for living donor liver transplantation
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DOI：
10.21037/hbsn.2016.11.05
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发表时间：
2016-12-01
影响因子：
8
通讯作者：
Lee, Sung-Gyu
中科院分区：
文献类型：
--
作者：
Kim, Seok-Hwan;Moon, Deok-Bog;Lee, Sung-Gyu
背景：成人活体肝移植（LDLT）是肝细胞癌（HCC）的最佳治疗方法之一。然而，当LDLT后发生HCC复发时，由于进展迅速，预后较差。据报道，术前甲胎蛋白 (AFP) 和维生素 K 拮抗剂 II (PIVKA-II) 诱导蛋白的水平与 LDLT 后 HCC 复发相关。方法：我们对 461 名自 2007 年 5 月起使用右肝移植治疗 HCC 接受 LDLT 的患者术前检查了 AFP 和 PIVKA-II 作为 HCC 复发的预测因子 至2013年12月。结果：对其中77例（16.7%）复发的患者进行回顾性分析。多变量分析显示肿瘤大小 >5 cm、AFP >150 nag/mol 和 PIVKA-II >100 maul/mol 是复发的重要独立危险因素。中位复发时间为 10 个月。复发后中位生存时间为26个月，复发后1年、3年和5年生存率分别为80.5%、58%和28.3%。结论：术前不仅肿瘤形态，AFP和PIVKA-II水平也可为HCC LDLT术后复发提供重要信息。因此，肿瘤标志物的组合可用于扩展现有的严格的 HCC 肝移植选择标准。
Background: Adult living donor liver transplantation (LDLT) is one of the best treatments for hepatocellular carcinoma (HCC). However, when recurrence of HCC after LDLT occurs, the prognosis is poor because of rapid progression. Preoperative level of alpha-fetoprotein (AFP) and protein induced by vitamin K antagonist-II (PIVKA-II) reportedly correlate with recurrence of HCC after LDLT.Methods: We examined AFP and PIVKA-II preoperatively as predictors of HCC recurrence in 461 patients who underwent LDLT using right liver graft for HCC from May 2007 to December 2013.Results: Among these, 77 patients (16.7%) who experienced recurrence were retrospectively reviewed. Multivariate analysis revealed tumor size >5 cm, AFP >150 nag/mol and PIVKA-II >100 maul/mol as significant independent risk factors for recurrence. The median time to recurrence was 10 months. The median survival time after recurrence was 26 months, and the 1-, 3- and 5-year survival rates after recurrence were 80.5%, 58%, and 28.3% respectively.Conclusions: Preoperatively, not only morphology of the tumor but also AFP and PIVKA-II levels can offers important information for the recurrence after LDLT for HCC. Thus, combination of tumor markers might be used for expansion of pre-existing strict selection criteria of liver transplantation for HCC.