Alpha-fetoprotein and 18F-FDG standard uptake value predict tumor recurrence after liver transplantation for hepatocellular carcinoma with portal vein tumor thrombosis: Preliminary experience.

Abstract

BACKGROUND:

Portal vein tumor thrombosis (PVTT) is regarded as a contraindication for liver transplantation (LT) in hepatocellular carcinoma (HCC). However, some of these patients may have a favorable prognosis after LT. In this study, we evaluated the biological behavior of HCC with PVTT using tumor biomarker (alpha-fetoprotein, AFP) and 18F-FDG positron emission tomography (tumor standard uptake value) to identify a subset of patients who may be suitable for LT.

METHODS:

Seventy-five HCC-PVTT liver recipients transplanted during February 2016 and June 2018 were analyzed. Different pre-transplant prognostic factors were identified by univariate and multivariate analyses. PVTT status was identified following Vp classification (Vp1-Vp4).

RESULTS:

Three-year recurrence-free survival and overall survival rates were 40% and 65.4% in Vp2-Vp3 PVTT patients, 21.4% and 30.6% in Vp4 PVTT patients (P < 0.05). Total tumor diameter >8 cm, pre-transplant AFP level >1000 ng/mL and intrahepatic tumor maximal standard uptake value (SUVmax-tumor >5) were independent risk factors for HCC recurrence and overall survival after LT in Vp2-3 PVTT patients. Low risk patients were defined as total tumor diameter ≤8 cm; or if total tumor diameter more than 8 cm, with both pre-transplant AFP level less than 1000 ng/mL and intrahepatic tumor SUVmax less than 5, simultaneously. Twenty-two Vp2-3 PVTT HCC patients (46.8%) were identified as low risk patients, and their 3-year recurrence-free and overall survival rates were 67.6% and 95.2%, respectively.

CONCLUSIONS:

Patients with segmental or lobar PVTT and biologically favorable tumors defined by AFP and 18F-FDG SUVmax might be suitable for LT.

• Authors: Zhe Yang, Fang-Zhou Luo, Shuo Wang, Jan Lerut, Li Zhuang, Qi-Yong Li, Xiao Xu, Shu-Sen Zheng
• Journal: Hepatobiliary & pancreatic diseases international : HBPD INT (Hepatobiliary Pancreat Dis Int) Vol. 19 Issue 3 Pg. 229-234 (Jun 2020) ISSN: 1499-3872 [Print] Singapore
• PMID: 32303439 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.

Chemical References

• Radiopharmaceuticals
• alpha-Fetoproteins
• Fluorodeoxyglucose F18

Topics

• Carcinoma, Hepatocellular (blood, diagnostic imaging, pathology, surgery)
• Female
• Fluorodeoxyglucose F18
• Humans
• Liver Neoplasms (blood, diagnostic imaging, pathology, surgery)
• Liver Transplantation
• Male
• Middle Aged
• Neoplasm Recurrence, Local (blood, diagnostic imaging)
• Neoplastic Cells, Circulating (pathology)
• Portal Vein (pathology)
• Positron-Emission Tomography
• Predictive Value of Tests
• Preoperative Period
• Radiopharmaceuticals
• Risk Factors
• Survival Rate
• Tumor Burden
• alpha-Fetoproteins (metabolism)