肝细胞癌患者“消融”与移植适应性决策模型的建立

StephenW

J Clin Gastroenterol. 2018 Jan 19. doi: 10.1097/MCG.0000000000000981. [Epub ahead of print]
A Model for Adaptive Decision Making of "Ablate-and-Wait" Versus Transplantation in Patients With Hepatocellular Carcinoma.Kim HY1, Kim W2, Jung YJ2, Lee JH2, Yu SJ2, Kim YJ2, Yoon JH2, Lee HW3, Kim H4, Yi NJ4, Lee KW4, Suh KS4.
Author information
1Department of Internal Medicine, College of Medicine, Ewha Womans University.2Departments of Internal Medicine.3Surgery, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine.4Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

AbstractBACKGROUND/AIMS: In patients with early-stage hepatocellular carcinoma (HCC), selection of candidates for liver transplantation (LT) requires refinement based on tumor biology to maximize the outcome. We aimed to prognosticate LT candidates with HCC using a risk prediction model for post-LT recurrence.
PATIENTS AND METHODS: A total of 197 consecutive patients were included who underwent LT for hepatitis B-related HCC within the Milan criteria. A risk prediction model was developed for post-LT recurrence using the Cox model and was internally validated.
RESULTS: Among those undergoing LT as their first HCC treatment (n=70, initial LT group), poor prognosis was associated with maximal tumor size and multinodularity. The remaining 127 patients (deferred LT group) received radiofrequency ablation (n=69) and/or transarterial chemoembolization (n=98) before LT. Multinodularity, maximal tumor size, posttransarterial chemoembolization progressive disease, baseline alpha-fetoprotein, and alpha-fetoprotein difference (between baseline and pre-LT) were incorporated into a risk prediction model for the deferred LT group, which was thereby stratified into low-risk (score<5), intermediate-risk, and high-risk (score≥8) subgroups. Recurrence-free survival was significantly different among the deferred LT prognostic subgroups (P<0.001).
CONCLUSIONS: This risk prediction model may help refinement of "ablate-and-wait" strategy for LT candidates by avoiding LT in those with either high risk score at baseline or increasing score under repeated locoregional therapies.


PMID:29356782DOI:10.1097/MCG.0000000000000981

StephenW

J Clin Gastroenterol。 2018年1月19日。doi：10.1097 / MCG.0000000000000981。 [电子版提前打印]
肝细胞癌患者“消融”与移植适应性决策模型的建立。
Kim HY1 Kim W2 Jung YJ2 Lee JH2 Yu SJ2 Kim YJ2 Yoon JH2 Lee HW3 Kim H4 Yi Y4 Lee Kw4 Suh KS4。
作者信息

1
    梨花女子大学医学部内科。
2
    内科医学系。
3
    首尔大都市政府Boramae医疗中心，首尔大学医学院外科。
4
    韩国首尔首尔国立大学医院汉城国立大学医学院外科。

抽象
背景/目的：

在早期肝细胞癌（HCC）患者中，选择肝移植候选者（LT）需要基于肿瘤生物学的精细化来最大化结果。我们的目的是使用风险预测模型来预测LT候选者与HCC之后的LT复发。
患者和方法：

在米兰标准中共纳入了197例连续接受LT治疗乙型肝炎相关HCC的患者。使用Cox模型开发了LT复发后的风险预测模型，并进行了内部验证。
结果：

首次接受LT治疗的患者（n = 70，初始LT组），预后差与最大肿瘤大小和多结节性有关。其余127例（延期LT组）接受射频消融（n = 69）和/或经动脉化疗栓塞（n = 98）。将多结节性，最大肿瘤大小，移行后化疗栓塞进展期疾病，基线甲胎蛋白和甲胎蛋白差异（基线与LT之前）纳入延期LT组的风险预测模型中，由此将其分层为低风险（分数<5），中等风险和高风险（分数≥8）亚组。延迟的LT预后亚组间无复发生存率显着不同（P <0.001）。
结论：

这种风险预测模型可能有助于细化LT候选者的“消融和等待”策略，避免在基线高风险评分或重复局部治疗评分增加的患者中使用LT。

结论：
    29356782
DOI：
    10.1097 / MCG.0000000000000981