Pretransplant trends in α-fetoprotein levels as a predictor of recurrence after living donor liver transplantation for unresectable hepatoblastoma: A single-institution experience.
Pretransplant trends in α-fetoprotein levels as a predictor of recurrence after living donor liver transplantation for unresectable hepatoblastoma: A single-institution experience.
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甲胎蛋白水平的移植前趋势作为不可切除肝母细胞瘤活体移植肝后复发的预测因子：单一机构的经验。
DOI：
10.1111/petr.13221
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发表时间：
2018
影响因子：
1.3
通讯作者：
Inomata Y.
中科院分区：
文献类型：
--
作者：
Isono K;Ohya Y;Lee KJ;Hashimoto S;Kadohisa M;Sakisaka M;Uto K;Hayashida S;Yamamoto H;Yamamoto H;Sugawara Y;Inomata Y.
肝移植是不可切除的肝母细胞瘤的一种实用的治疗选择;然而，决定何时进行肝移植是困难的。本研究的目的是利用移植前AFP水平的变化趋势来优化肝母细胞瘤的LT时机。回顾性评估了移植前AFP水平的趋势及其对移植后结局的影响。纳入了自2002年以来在我们机构接受活体肝移植治疗肝母细胞瘤的所有患者。分析的变量包括既往肿瘤切除史、移植前AFP对化疗的反应、诊断时的转移性疾病和移植后化疗。8名患者（7名男孩和1名女孩;中位年龄为35个月;范围为15个月-12岁）接受了移植。总体移植后无复发生存率为62.5%（5/8），平均随访77个月。移植后复发的患者在LT前的最后一次化疗后AFP水平增加了0.573 log。这显著高于在没有移植后复发的患者中观察到的0.279 log下降（P= 0.024）。由于在每个化疗周期之前无法准确预测AFP反应，因此当AFP水平在最后一个周期之后并且在发现其再次升高之前不降低时，进行LT可能是适当的。
LT is a practical therapeutic alternative for unresectable hepatoblastoma; however, deciding when to perform LT is difficult. The aim of this study was to optimize the timing of LT for hepatoblastoma using pretransplant trends in AFP levels. Trends in pretransplant AFP levels and their influence on post‐transplant outcomes were retrospectively evaluated. All patients who underwent living donor LT for hepatoblastoma in our institution since 2002 were included. Variables analyzed included history of prior tumor resection, pretransplant AFP responses to chemotherapy, metastatic disease at diagnosis, and post‐transplant chemotherapy. Eight patients (seven boys and one girl; median age, 35 months; range, 15 months‐12 years) were transplanted. The overall post‐transplant recurrence‐free survival rate was 62.5% (5/8) with a mean follow‐up of 77 months. Patients with post‐transplant recurrence showed a 0.573 log increase in AFP levels after the last chemotherapy session before LT. This was significantly higher than the 0.279 log decrease observed in patients without post‐transplant recurrence (P= .024). Because the AFP response cannot be accurately predicted before each cycle of chemotherapy, it may be appropriate to perform LT when AFP levels do not decrease after the last cycle and before they are found to be elevated again.