α-Fetoprotein is a potential survival predictor in hepatocellular carcinoma patients with hepatitis B selected for liver transplantation
α-Fetoprotein is a potential survival predictor in hepatocellular carcinoma patients with hepatitis B selected for liver transplantation
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DOI：
10.1097/meg.0000000000000029
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发表时间：
2014-05-01
影响因子：
2.1
通讯作者：
Shen, Zhongyang
中科院分区：
文献类型：
--
作者：
Zhang, Qing;Shang, Lei;Shen, Zhongyang
背景危险因素可影响抗病毒预防的原位肝移植(OLT)治疗乙肝病毒相关性肝细胞癌(HCC)和肝硬变后的存活率和预后。目的探讨采用两种候选策略选择的肝细胞癌/乙肝病毒相关性肝硬变患者行肝移植的危险因素。患者与方法回顾分析2002年7月至2006年12月203例肝细胞癌/乙肝肝硬变患者行肝移植联合抗病毒治疗的临床资料。符合米兰标准(保守候选组)或符合七项标准但不符合米兰标准(包含候选组)的无并发症肝细胞癌患者纳入其中。患者术后接受免疫抑制治疗。评估患者的无瘤生存期和总生存期。单因素分析包括甲胎蛋白(AFP)、天冬氨酸氨基转移酶、丙氨酸氨基转移酶、肿瘤大小、肿瘤结节数、血管侵犯、淋巴结转移和分化程度。以甲胎蛋白(AFP)水平(200 ng/ml)为基础，比较三组间的OS。结果保守候选组OS和无瘤生存率均好于包容候选组。在包含候选的组中，低AST、高肿瘤分化和低AFP与OS的改善显著相关(P<；0.05)。在保守候选组中，低肿瘤结节数和AFP水平与OS的改善显著相关(P<；0.05)。AFP>200 ng/ml表明所有组的预后较差。在多因素分析中，AFP是OS的独立预测因子。结论根据AFP、AST和肿瘤分化程度对最多7项标准进行分层可能更合适，AFP是选择进行原位肝移植的乙肝病毒相关性肝细胞癌患者的潜在独立生存预测指标。
Background Risk factors can affect candidacy and prognosis following orthotopic liver transplantation (OLT) with antiviral prophylaxis for the treatment of hepatocellular carcinoma (HCC) associated with hepatitis B virus (HBV) and cirrhosis. Objective The objective of this study was to investigate the risk factors affecting OLT outcomes in patients with HCC/HBV-induced cirrhosis selected by two contemporary candidacy strategies. Patients and methods From July 2002 to December 2006, 203 patients with HCC/HBV-cirrhosis undergoing OLT with antiviral prophylaxis were evaluated retrospectively. Patients with uncomplicated HCC fulfilling Milan (conservative candidacy group) or Up-to-Seven but not Milan (inclusive candidacy group) criteria were included. Patients received postoperative immunosuppressive therapy. Tumor-free survival and overall survival (OS) were assessed. Univariate analyses between OS and clinical/demographic factors were carried out, including alpha-fetoprotein (AFP), aspartate aminotransferase, alanine aminotransferase, tumor size, tumor nodule number, vascular invasion, lymph node metastasis, and degree of differentiation. OS was compared between the three groups on the basis of AFP level ( 200 ng/ml). Results Conservative candidacy group OS and tumor-free survival were better than the inclusive candidacy group. Low AST, high tumor differentiation, and low AFP were significantly associated with improved OS in the inclusive candidacy group (P < 0.05). Low tumor nodule number and AFP levels were significantly associated with improved OS in the conservative candidacy group (P < 0.05). AFP of more than 200 ng/ml indicated poorer outcomes in all groups. In multivariate analysis, AFP was an independent predictor of OS. Conclusion Up-to-Seven criteria may be more appropriately stratified by AFP, AST, and tumor differentiation, and AFP is a potential independent survival predictor in HBV-associated HCC patients selected for OLT.