Preoperative alpha-fetoprotein and 18F-FDG PET predict tumor recurrence better than Milan criteria in living donor liver transplantation
- 주제(키워드) Alpha-fetoproteins , Biological factors , Fluorodeoxyglucose F18 , Hepatocellular carcinoma , Liver transplantation , Living donors , Positron emission tomography
- 등재 SCIE, SCOPUS
- 발행기관 Elsevier
- 발행년도 2016
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000124268
- 본문언어 영어
- Published As http://dx.doi.org/10.1016/j.jhep.2015.11.033
- 저작권 이화여자대학교 논문은 저작권에 의해 보호받습니다.
초록/요약
Background & Aims: 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 (200ng/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. © 2015 European Association for the Study of the Liver.
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