Volume 14 Issue 2
Mar.  2023
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Yan Cheng, Chen Xinguo, Jin Hailong, et al. 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[J]. ORGAN TRANSPLANTATION, 2023, 14(2): 248-256. doi: 10.3969/j.issn.1674-7445.2023.02.011
Citation: Yan Cheng, Chen Xinguo, Jin Hailong, et al. 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[J]. ORGAN TRANSPLANTATION, 2023, 14(2): 248-256. doi: 10.3969/j.issn.1674-7445.2023.02.011
shu

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

doi: 10.3969/j.issn.1674-7445.2023.02.011

  • Weifang Medical University, Weifang 261053, China

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  • Corresponding author: Zhang Qing, Email: zqy6920@sina.com
  • Received Date: 2022-10-18
    Available Online: 2023-03-15
  • Publish Date: 2023-03-15
    Abstract
  •   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.

     

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    • References(35)
  • [1]
    SUNG H, FERLAY J, SIEGEL R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. DOI: 10.3322/caac.21660.
    [2]
    CAO W, CHEN HD, YU YW, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020[J]. Chin Med J (Engl), 2021, 134(7): 783-791. DOI: 10.1097/CM9.0000000000001474.
    [3]
    INCE V, SAHIN TT, AKBULUT S, et al. Liver transplantation for hepatocellular carcinoma: historical evolution of transplantation criteria[J]. World J Clin Cases, 2022, 10(29): 10413-10427. DOI: 10.12998/wjcc.v10.i29.10413.
    [4]
    SAPISOCHIN G, BRUIX J. Liver transplantation for hepatocellular carcinoma: outcomes and novel surgical approaches[J]. Nat Rev Gastroenterol Hepatol, 2017, 14(4): 203-217. DOI: 10.1038/nrgastro.2016.193.
    [5]
    XU X, LU D, LING Q, et al. Liver transplantation for hepatocellular carcinoma beyond the Milan criteria[J]. Gut, 2016, 65(6): 1035-1041. DOI: 10.1136/gutjnl-2014-308513.
    [6]
    TONIUTTO P, FUMOLO E, FORNASIERE E, et al. Liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a comprehensive review[J]. J Clin Med, 2021, 10(17): 3932. DOI: 10.3390/jcm10173932.
    [7]
    AKBULUT S, KOC C. Do we need to be limited by matching Milan criteria for survival in living donor liver transplantation?[J]. J Gastrointest Cancer, 2020, 51(4): 1107-1113. DOI: 10.1007/s12029-020-00482-0.
    [8]
    LINGIAH V A, NIAZI M, OLIVO R, et al. Liver transplantation beyond Milan criteria[J]. J Clin Transl Hepatol, 2020, 8(1): 69-75. DOI: 10.14218/JCTH.2019.00050.
    [9]
    TONIUTTO P, FORNASIERE E, FUMOLO E, et al. Risk factors for hepatocellular carcinoma recurrence after liver transplantation[J]. Hepatoma Res, 2020, 6(8): 46-66. DOI: 10.20517/2394-5079.2020.40.
    [10]
    NOTARPAOLO A, LAYESE R, MAGISTRI P, et al. Validation of the AFP model as a predictor of HCC recurrence in patients with viral hepatitis-related cirrhosis who had received a liver transplant for HCC[J]. J Hepatol, 2017, 66(3): 552-559. DOI: 10.1016/j.jhep.2016.10.038.
    [11]
    ZHANG LX, LV Y, XU AM, et al. The prognostic significance of serum gamma-glutamyltransferase levels and AST/ALT in primary hepatic carcinoma[J]. BMC Cancer, 2019, 19(1): 841. DOI: 10.1186/s12885-019-6011-8.
    [12]
    LI ZC, LI Z, LI C, et al. Letter: elevated aspartate aminotransferase and aspartate aminotransferase to alanine aminotransferase ratio predicts poor survival in hepatocellular carcinoma after resection[J]. Aliment Pharmacol Ther, 2020, 52(11/12): 1762-1763. DOI: 10.1111/apt.16124.
    [13]
    GUO C, LIANG H, YUAN W, et al. Analysis on the value of soluble intercellular adhesion molecule-1 (sICAM-1), alpha fetoprotein (AFP), and aspartate aminotransferase/platelet ratio index (APRI) in predicting the prognostic survival of patients with primary liver cancer after radiofrequency ablation[J]. Ann Palliat Med, 2021, 10(4): 4760-4767. DOI: 10.21037/apm-21-749.
    [14]
    ALIM A, ERDOGAN Y, DAYANGAC M, et al. Living donor liver transplantation: the optimal curative treatment for hepatocellular carcinoma even beyond Milan criteria[J]. Cancer Control, 2021, 28: 10732748211011960. DOI: 10.1177/10732748211011960.
    [15]
    XU DW, WAN P, XIA Q. Liver transplantation for hepatocellular carcinoma beyond the Milan criteria: a review[J]. World J Gastroenterol, 2016, 22(12): 3325-3334. DOI: 10.3748/wjg.v22.i12.3325.
    [16]
    方海星, 鲁迪, 卓建勇, 等. 肝癌肝移植杭州标准应用于肝癌切除术预后的评价[J]. 中华普通外科杂志, 2018, 33(11): 904-906. DOI: 10.3760/cma.j.issn.1007-631X.2018.11.003.

    FANG HX, LU D, ZHUO JY, et al. Prognostic evaluation of candidate selection Hangzhou criteria of hepatocellular carcinoma for liver transplantation after hepatectomy[J]. Chin J Gen Surg, 2018, 33(11): 904-906. DOI: 10.3760/cma.j.issn.1007-631X.2018.11.003.
    [17]
    INCE V, AKBULUT S, OTAN E, et al. Liver transplantation for hepatocellular carcinoma: malatya experience and proposals for expanded criteria[J]. J Gastrointest Cancer, 2020, 51(3): 998-1005. DOI: 10.1007/s12029-020-00424-w.
    [18]
    RANGWANI S, ARDESHNA D R, MUMTAZ K, et al. Update on endoscopic ultrasound-guided liver biopsy[J]. World J Gastroenterol, 2022, 28(28): 3586-3594. DOI: 10.3748/wjg.v28.i28.3586.
    [19]
    KHALIFA A, ROCKEY D C. The utility of liver biopsy in 2020[J]. Curr Opin Gastroenterol, 2020, 36(3): 184-191. DOI: 10.1097/MOG.0000000000000621.
    [20]
    CORTI A, BELCASTRO E, DOMINICI S, et al. The dark side of gamma-glutamyltransferase (GGT): pathogenic effects of an 'antioxidant' enzyme[J]. Free Radic Biol Med, 2020, 160: 807-819. DOI: 10.1016/j.freeradbiomed.2020.09.005.
    [21]
    ZHANG Q, JIAO X. LDH and GGT/ALT ratio as novel prognostic biomarkers in hepatocellular carcinoma patients after liver transplantation[J]. Comput Math Methods Med, 2021: 9809990. DOI: 10.1155/2021/9809990.
    [22]
    FU SJ, ZHAO Q, JI F, et al. Elevated preoperative serum gamma-glutamyltranspeptidase predicts poor prognosis for hepatocellular carcinoma after liver transplantation[J]. Sci Rep, 2016, 6: 28835. DOI: 10.1038/srep28835.
    [23]
    FU S, GUO Z, LI S, et al. Prognostic value of preoperative serum gamma-glutamyltranspeptidase in patients with hepatocellular carcinoma after hepatectomy[J]. Tumour biol, 2016, 37(3): 3433-3440. DOI: 10.1007/s13277-015-4136-1.
    [24]
    MA H, ZHANG L, TANG B, et al. gamma-glutamyltranspeptidase is a prognostic marker of survival and recurrence in radiofrequency-ablation treatment of hepatocellular carcinoma[J]. Ann Surg Oncol, 2014, 21(9): 3084-3089. DOI: 10.1245/s10434-014-3724-4.
    [25]
    LI JH, CHEN T, XING H, et al. The AGH score is a predictor of disease-free survival and targeted therapy efficacy after liver transplantation in patients with hepatocellular carcinoma[J]. Hepatobiliary Pancreat Dis Int, 2022, DOI: 10.1016/j.hbpd.2022.04.003[Epubaheadofprint].
    [26]
    ÖZDEMIR F, BASKIRAN A. The importance of AFP in liver transplantation for HCC[J]. J Gastrointest Cancer, 2020, 51(4): 1127-1132. DOI: 10.1007/s12029-020-00486-w.
    [27]
    KOCH C, BETTE T, WAIDMANN O, et al. AFP ratio predicts HCC recurrence after liver transplantation[J]. PLoS One, 2020, 15(7): e0235576. DOI: 10.1371/journal.pone.0235576.
    [28]
    SCHLOSSER S, TÜMEN D, VOLZ B, et al. HCC biomarkers - state of the old and outlook to future promising biomarkers and their potential in everyday clinical practice[J]. Front Oncol, 2022, 12: 1016952. DOI: 10.3389/fonc.2022.1016952.
    [29]
    RUCH B, WAGLER J, KUMM K, et al. Hepatocellular carcinoma, alpha fetoprotein, and liver allocation for transplantation: past, present and future[J]. Curr Oncol, 2022, 29(10): 7537-7551. DOI: 10.3390/curroncol29100593.
    [30]
    ZHANG DL, FENG DN, HE X, et al. The combination of AFP and "Up-to-seven" criteria may be a better strategy for liver transplantation in Chinese cirrhotic HCC patients[J]. Front Oncol, 2022, 12: 959151. DOI: 10.3389/fonc.2022.959151.
    [31]
    MAZZAFERRO V, SPOSITO C, ZHOU J, et al. Metroticket 2.0 model for analysis of competing risks of death after liver transplantation for hepatocellular carcinoma[J]. Gastroenterology, 2018, 154(1): 128-139. DOI: 10.1053/j.gastro.2017.09.025.
    [32]
    PAVEL MC, FUSTER J. Expansion of the hepatocellular carcinoma Milan criteria in liver transplantation: future directions[J]. World J Gastroenterol, 2018, 24(32): 3626-3636. DOI: 10.3748/wjg.v24.i32.3626.
    [33]
    YAO FY, FERRELL L, BASS NM, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival[J]. Hepatology, 2001, 33(6): 1394-1403. DOI: 10.1053/jhep.2001.24563.
    [34]
    LIANG HR, HSIEH CE, LIN KH, et al. Living donor liver transplantation for hepatocellular carcinoma beyond the Milan criteria: outcome of expanded criteria in tumor size[J]. BMC Surg, 2021, 21(1): 401. DOI: 10.1186/s12893-021-01403-z.
    [35]
    INCE V, ARA C, YILMAZ S. Malatya and other criteria for liver transplantation in hepatocellular carcinoma[J]. J Gastrointest Cancer, 2020, 51(4): 1118-1121. DOI: 10.1007/s12029-020-00484-y.
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