Alpha-fetoprotein and ¹⁸F-FDG positron emission tomography predict tumor recurrence better than Milan criteria in living donor liver transplantation

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• 作者：Geun Hong¹ ; Kyung-Suk Suh² ; ^{kssuh@snu.ac.kr" class="auth_mail" title="E-mail the corresponding author} ; Suk-won Suh² ; Tae Yoo² ; Hyeyoung Kim² ; Min-Su Park² ; YoungRok Choi² ; Jin Chul Paeng³ ; Nam-Joon Yi² ; Kwang-Woong Lee²
• 关键词：LT ; liver transplantation ; HCC ; hepatocellular carcinoma ; LDLT ; live-donor liver transplantation ; SRTR ; Scientific Registry of Transplant Recipients ; 18F-FDG PET ; 18Ffluorodeoxyglucose positron emission tomography ; AFP ; alpha-fetoprotein ; MELD ; model for end-stage liver disease ; CT ; computed tomography ; MRI ; magnetic resonance imaging ; RECIST ; response evaluation criteria in solid tumors ; ROC ; receiver operating characteristic ; AUC ; area under the curve ; DFSR ; disease-free survival rate ; SR ; sur
• 刊名：Journal of Hepatology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：64
• 期：4
• 页码：852-859
• 全文大小：1012 K

文摘

Given the organ shortage for liver transplantation (LT) and the limitations of the current morphology-based selection criteria, improved criteria are needed to achieve the maximum benefit of LT for hepatocellular carcinoma (HCC). We hypothesized that a combination of biological markers may better predict the prognosis than the Milan criteria.

Methods

HCC patients (n = 123) with preoperative data on serum alpha-fetoprotein (AFP) levels and ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) positivity underwent live-donor LT between January 2003 and December 2009. The cut-off values for serum AFP levels (200 ng/ml) and ¹⁸F-FDG PET positivity (1.10) for tumor recurrence were determined by c-statistics using receiver operating characteristic curves. Univariate and multivariate analyses with preoperative variables were performed to find pre-transplant prognostic factors. Disease-free survival rates and overall survival rates were analysed with regard to serum AFP levels and ¹⁸F-FDG PET positivity.

Results

The 5-year disease-free survival rates and overall survival rates were 80.3% and 81.6% respectively. ¹⁸F-FDG PET positivity (hazard ratio (HR) 9.766, 95% CI 3.557–26.816; p <0.001) and serum AFP level (HR 6.234, 95% CI 2.643–14.707; p <0.001) were the only significant pre-transplant prognostic factors in the multivariate analysis; tumor number and size were not significant.

A combination of criteria showed that the biologically high-risk group (AFP level ⩾200 ng/ml and PET-positive) had an HR of 29.069 (95% CI 8.797–96.053; p <0.001) compared with the double-negative group. Use of the Milan criteria yielded an HR of 1.351 (95% CI 0.500–3.652; p = 0.553).

Conclusions

The combination of the serum AFP level and ¹⁸F-FDG PET data predicted better outcomes than those using the Milan criteria, improving objectivity when adult-to-adult living donor LT is contemplated.