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Preoperative alpha-fetoprotein and 18F-FDG PET predict tumor recurrence better than Milan criteria in living donor liver transplantation

Title
Preoperative alpha-fetoprotein and 18F-FDG PET predict tumor recurrence better than Milan criteria in living donor liver transplantation
Authors
Hong G.Suh K.-S.Suh S.-W.Yoo T.Kim H.Park M.-S.Choi Y.R.Paeng J.C.Yi N.-J.Lee K.-W.
Ewha Authors
홍근
SCOPUS Author ID
홍근scopus
Issue Date
2016
Journal Title
Journal of Hepatology
ISSN
0168-8278JCR Link
Keywords
Alpha-fetoproteinsBiological factorsFluorodeoxyglucose F18Hepatocellular carcinomaLiver transplantationLiving donorsPositron emission tomography
Publisher
Elsevier
Indexed
SCI; SCIE; SCOPUS scopus
Abstract
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.
DOI
10.1016/j.jhep.2015.11.033
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의과대학 > 의학과 > Journal papers
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