去γ-羧基凝血酶原在活体肝移植治疗复发性肝细胞癌中的预后影响

Prognostic impact of des-γ-carboxyl prothrombin in living-donor liver transplantation for recurrent hepatocellular carcinoma.

作者信息

Harimoto N, Yoshida Y, Kurihara T, Takeishi K, Itoh S, Harada N, Tsujita E, Yamashita Y-I, Uchiyama H, Soejima Y, Ikegami T, Yoshizumi T, Kawanaka H, Ikeda T, Shirabe K, Saeki H, Oki E, Kimura Y, Maehara Y

机构信息

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

出版信息

Transplant Proc. 2015 Apr;47(3):703-4. doi: 10.1016/j.transproceed.2014.09.178. Epub 2015 Mar 27.

DOI:10.1016/j.transproceed.2014.09.178

PMID:25819732

Abstract

BACKGROUND

Although the Milan criteria are widely accepted for liver transplantation (LT) in patients for hepatocellular carcinoma (HCC), they have not been fully evaluated for salvage LT in patients with recurrent HCC. We have previously reported outcomes of living-donor LT (LDLT) for HCC and identified 2 risk factors affecting recurrence-free survival (RFS): tumor size >5 cm and des-γ-carboxyl prothrombin (DCP) concentration >300 mAU/mL (Kyushu University criteria). This study was designed to clarify risk factors for tumor recurrence after LDLT in patients with recurrent HCC.

METHODS

Outcomes in 114 patients who underwent LDLT for recurrent HCC were analyzed retrospectively. RFS rates after LDLT were calculated, and risk factors for tumor recurrence were identified.

RESULTS

The 1-, 3-, and 5-year RFS rates after LDLT were 90.6%, 80.4%, and 78.8%, respectively. Univariate analysis showed that tumor recurrence was associated with alpha-fetoprotein concentration ≥ 300 ng/mL, DCP concentration ≥ 300 mAU/mL, tumor number ≥ 4, tumor size ≥ 5 cm, transarterial chemotherapy before LDLT, duration of last treatment of HCC to LDLT <3 months, bilobar distribution, exceeding Milan criteria, exceeding Kyushu University criteria, poor differentiation, and histologic vascular invasion. Multivariate analysis showed that DCP ≥ 300 mAU/mL (P = .03) and duration from last treatment to LDLT <3 months (P = .01) were independent predictors of RFS.

CONCLUSIONS

DCP concentration and time between last treatment and LDLT are prognostic of RFS in patients undergoing LDLT for HCC.

摘要

背景

尽管米兰标准在肝细胞癌（HCC）患者肝移植（LT）中被广泛接受，但对于复发性HCC患者的挽救性肝移植，该标准尚未得到充分评估。我们之前报道了活体肝移植（LDLT）治疗HCC的结果，并确定了影响无复发生存期（RFS）的两个危险因素：肿瘤大小>5 cm和去γ-羧基凝血酶原（DCP）浓度>300 mAU/mL（九州大学标准）。本研究旨在明确复发性HCC患者接受LDLT后肿瘤复发的危险因素。

方法

回顾性分析114例接受LDLT治疗复发性HCC患者的结局。计算LDLT后的RFS率，并确定肿瘤复发的危险因素。

结果

LDLT后的1年、3年和5年RFS率分别为90.6%、80.4%和78.8%。单因素分析显示，肿瘤复发与甲胎蛋白浓度≥300 ng/mL、DCP浓度≥300 mAU/mL、肿瘤数量≥4、肿瘤大小≥5 cm、LDLT前经动脉化疗、HCC最后一次治疗至LDLT的持续时间<3个月、双叶分布、超过米兰标准、超过九州大学标准、低分化及组织学血管侵犯有关。多因素分析显示，DCP≥300 mAU/mL（P = 0.03）和最后一次治疗至LDLT的持续时间<3个月（P = 0.01）是RFS的独立预测因素。