Background/aims

Hepatocellular carcinoma (HCC) is a leading indication for liver transplantation (LT) worldwide. Early identification of patients at risk for HCC recurrence is of paramount importance since early treatment of recurrent HCC after LT may be associated with increased survival. We evaluated incidence of and predictors for HCC recurrence, with a focus on the course of AFP levels.

Methods

We performed a retrospective, single-center study of 99 HCC patients who underwent LT between January 28^th, 1997 and May 11^th, 2016. A multi-stage proportional hazards model with three stages was used to evaluate potential predictive markers, both by univariate and multivariable analysis, for influences on 1) recurrence after transplantation, 2) mortality without HCC recurrence, and 3) mortality after recurrence.

Results

19/99 HCC patients showed recurrence after LT. Waiting time was not associated with overall HCC recurrence (HR = 1, p = 0.979). Similarly, waiting time did not affect mortality in LT recipients both with (HR = 0.97, p = 0.282) or without (HR = 0.99, p = 0.685) HCC recurrence. Log₁₀-transformed AFP values at the time of LT (HR 1.75, p = 0.023) as well as after LT (HR 2.07, p = 0.037) were significantly associated with recurrence. Median survival in patients with a ratio (AFP at recurrence divided by AFP 3 months before recurrence) of 0.5 was greater than 70 months, as compared to a median of only 8 months in patients with a ratio of 5.

Conclusion

A rise in AFP levels rather than an absolute threshold could help to identify patients at short-term risk for HCC recurrence post LT, which may allow intensification of the surveillance strategy on an individualized basis.

中文翻译：

---

AFP比率预测肝移植后HCC复发。

背景/目标

肝细胞癌（HCC）是世界范围内肝移植（LT）的主要适应症。尽早发现具有HCC复发风险的患者至关重要，因为LT后复发性HCC的早期治疗可能会增加生存率。我们评估了肝癌复发的发生率和预测因素，重点是AFP水平的变化过程。

方法

我们对1997年1月28^日至2016年5月11^日接受LT的99例HCC患者进行了一项回顾性，单中心研究。采用三阶段的多阶段比例风险模型，通过单因素评估潜在的预测指标和多变量分析，以了解对以下因素的影响：1）移植后复发，2）无HCC复发的死亡率和3）复发后的死亡率。

结果

19/99 HCC患者在LT后出现复发。等待时间与总体HCC复发无关（HR = 1，p = 0.979）。同样，无论有（HR = 0.97，p = 0.282）或没有（HR = 0.99，p = 0.685）HCC复发，等待时间都不会影响LT接受者的死亡率。LT（HR 1.75，p = 0.023）以及LT之后（HR 2.07，p = 0.037）的Log _{10转换后的}AFP值与复发密切相关。比率（复发时的AFP除以复发前3个月的AFP）为0.5的患者中位生存期大于70个月，而比率为5的患者中位生存期仅为8个月。

结论

AFP水平的升高而不是绝对阈值的升高可能有助于确定患有LT后HCC复发的短期风险的患者，这可能允许在个体基础上加强监测策略。