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| Alpha-fetoprotein and 18 F-FDG standard uptake value predict tumor recurrence after liver transplantation for hepatocellular carcinoma with portal vein tumor thrombosis: Preliminary experience |
| Zhe Yang a , b , c , Fang-Zhou Luo b , Shuo Wang a , Jan Lerut d , Li Zhuang a , Qi-Yong Li a , Xiao Xu b , c , Shu-Sen Zheng a , b , c , ∗ |
a Department of Hepatobiliary and Pancreatic Surgery, Department of Liver Transplantation, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou, China
b Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
c National Clinical Research Center of Infectious Diseases, Hangzhou, China
d Starzl Unit of Abdominal Transplantation, University Hospitals Saint Luc, Universitécatholique Louvain, Brussels, Belgium
∗ Corresponding author: Shu-Sen Zheng, Department of Hepatobiliary and Pancreatic Surgery, Department of Liver Transplantation, Shulan (Hangzhou) Hospital, 848 Dongxin Road, Hangzhou 310000, China.
E-mail address: shusenzheng@zju.edu.cn (S.-S. Zheng).
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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 18 F-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 > 10 0 0 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 10 0 0 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 18 F-FDG SUVmax might be suitable for LT.
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2020, Vol. 19 
