基于术前血清学指标AFP和GGT的标准在预测肝细胞癌患者肝移植术后长期生存中的作用研究

目的  分析术前血清学指标对肝细胞癌（HCC）患者肝移植术后长期生存和肿瘤复发的预测作用，探索其对扩大米兰标准的意义。方法  回顾性分析669例HCC肝移植受者的临床资料，采用受试者工作特征（ROC）曲线计算最佳截取值，采用单因素和多因素回归分析影响HCC患者肝移植术后总生存率和无复发生存率的危险因素，分析术前血清肝酶与肿瘤病理学特征的相关性，比较甲胎蛋白（AFP）联合γ-谷氨酰转移酶（GGT）以及不同肝移植标准对HCC患者肝移植术后生存和复发的预测价值。结果  超米兰标准、肿瘤直径之和（TTD） > 8 cm、AFP > 200 ng/mL和GGT > 84 U/L是影响HCC患者肝移植术后总生存率和无复发生存率的独立危险因素（均为P < 0.05）。相关性分析结果显示，术前血清GGT水平与TTD，肿瘤数量，静脉侵犯，微卫星病变，包膜侵犯，肿瘤、淋巴结、转移（TNM）分期，Child-Pugh评分，超米兰标准均存在相关性（均为P < 0.05）。将米兰标准、TTD与血清肝酶指标（AFP和GGT）结合，提出Milan-AFP-GGT-TTD（M-AGT）标准。符合M-AGT标准者（其中111例超米兰标准）术后5年总生存率和无复发生存率均高于符合杭州标准者（均为P < 0.05），与符合加州大学旧金山分校（UCSF）标准者的术后5年总生存率和无复发生存率比较差异均无统计学意义（均为P > 0.05）。结论  术前血清学指标AFP和GGT可有效预测HCC患者肝移植术后长期生存和肿瘤复发，建立基于血清学指标的M-AGT标准有助于补充米兰标准，且简单易行。

Role of the criteria based on preoperative serological indexes of AFP and GGT in predicting long-term survival of patients with hepatocellular carcinoma after liver transplantation

Objective To evaluate the role of preoperative serological indexes in predicting long-term survival and tumor recurrence of hepatocellular carcinoma (HCC) patients after liver transplantation, aiming to explore its significance in expanding the Milan criteria. Methods Clinical data of 669 recipients undergoing liver transplantation for HCC were retrospectively analyzed. The optimal cut-off value was calculated by the receiver operating characteristic (ROC) curve. The risk factors affecting the overall survival and recurrence-free survival rates of HCC patients after liver transplantation were identified by univariate and multivariate regression analyses. The correlation between preoperative serum liver enzymes and pathological characteristics in HCC patients was analyzed. The predictive values of alpha-fetoprotein (AFP) combined with γ -glutamyl transferase (GGT) and different liver transplant criteria for the survival and recurrence of HCC patients after liver transplantation were compared. Results Exceeded Milan criteria, total tumor diameter (TTD) > 8 cm, AFP > 200 ng/mL and GGT > 84 U/L were the independent risk factors for the overall survival and recurrence-free survival rates of HCC patients after liver transplantation (all P < 0.05). Correlation analysis showed that preoperative serum GGT level was correlated with TTD, number of tumor, venous invasion, microsatellite lesions, capsular invasion, tumor, node, metastasis (TNM) stage, Child-Pugh score and exceeded Milan criteria (all P < 0.05). Milan-AFP-GGT-TTD (M-AGT) criteria were proposed by combining Milan criteria, TTD with serum liver enzyme indexes (AFP and GGT). The 5-year overall survival and recurrence-free survival rates of HCC recipients who met the M-AGT criteria (111 cases of exceeded Milan criteria) were significantly higher than those who met Hangzhou criteria (both P < 0.05), whereas had no significant difference from their counterparts who met the University of California at San Francisco (UCSF) criteria (both P > 0.05). Conclusions Preoperative serological indexes of AFP and GGT could effectively predict the long-term survival and tumor recurrence of HCC patients after liver transplantation. Establishing the M-AGT criteria based on serological indexes contributes to expanding the Milan criteria, which is convenient and feasible.