18F-FDG PET/CT纳入肝细胞癌肝移植标准的趋势与价值

肝移植是治疗肝细胞癌(HCC)的有效方法,为降低HCC肝移植术后可能出现较高肿瘤复发率,有学者率先提出著名的Milan标准。但该标准过于严格,部分患者因其肿瘤病变较大或多个结节,虽其生物行为相对“温良”,也被排除在等待肝移植名单之外,随之世界各地出现了众多的“扩大Milan版标准”。HCC组织病理学的微血管侵犯(MVI)、肿瘤组织低分化与HCC肝移植术后较高复发率有显著相关性。复习总结了近年来国内外18氟-脱氧葡萄糖(18F-FDG)PET/CT在HCC肝移植方面的应用文献,发现18F-FDG在HCC病变部位不同的摄取程度,反映了肿瘤组织生物学行为特征即侵袭性的差异;18F-FDG高摄取与HCC病变的MVI、低分化呈正相关;18F-FDG还能敏感、准确地发现HCC肝外转移灶。认为术前18F-FDG PET/CT结果对HCC肝移植预后评估有巨大价值,将其结果纳入HCC肝移植标准是趋势所归,也有望统一“扩大Milan版标准”。建议新的肝移植标准可定义为,原则上遵循Milan标准;对超出Milan标准者,满足HCC病变18F-FDG PET/CT阴性,且排除大血管侵犯和肝外转移。

The trend and value of18F-FDG PET/CT included in the criteria for liver transplantation in hepatocellular carcinoma

Liver transplantation is an effective method for the treatment of hepatocellular carcinoma (HCC). In order to reduce the high recurrence rate of tumor after liver transplantation for HCC, some scholars put forward the famous Milan criteria. Since the Milan criteria are too strict, some HCC patients with relatively “good biological behavior” and large lesions or multiple nodules are excluded from the waiting list for liver transplantation, and thus a large number of “expanded versions of the Milan criteria” appeared around the world. As for the histopathology of HCC, microvascular invasion (MVI) and poorly differentiated tumor tissue are significantly associated with the high recurrence rate after liver transplantation for HCC. This article reviews and summarizes the articles on the application of 18F-FDG PET/CT in liver transplantation for HCC in China and foreign countries and points out that the uptake of 18F-FDG in HCC lesions reflects the difference in the biological behavior (i.e., invasion) of tumor tissue. The intense uptake of 18F-FDG is positively correlated with MVI and poor differentiation of HCC. In addition, 18F-FDG can detect extrahepatic metastatic lesions sensitively and accurately. Preoperative 18F-FDG PET/CT findings have a high value in predicting the prognosis of liver transplantation for HCC, and it is a trend to incorporate such findings into the criteria for liver transplantation in HCC. It is also expected to unify the various expanded versions of the Milan criteria. The new criteria for liver transplantation may be defined as follows: the Milan criteria should be followed in general;as for the patients who do not meet the Milan criteria, liver transplantation can be performed for those who have lesions with negative 18F-FDG PET/CT results, without the involvement of major blood vessels or extrahepatic metastasis.