Yasutsugu Takada1, Toshimi Kaido2, Ken Shirabe3, Hiroaki Nagano4, Hiroto Egawa5, Yasuhiko Sugawara6, Akinobu Taketomi7, Takeshi Takahara8, Go Wakabayashi9, Chikashi Nakanishi10, Naoki Kawagishi10, Akira Kenjo11, Mitsukazu Gotoh11, Yoshikazu Toyoki12, Kenichi Hakamada12, Masayuki Ohtsuka13, Nobuhisa Akamatsu14, Norihiro Kokudo14, Kazuhisa Takeda15, Itaru Endo16, Hiroyuki Takamura17, Hideaki Okajima2, Hiroshi Wada18, Shoji Kubo19, Kaoru Kuramitsu20, Yonson Ku20, Kohei Ishiyama21, Hideki Ohdan21, Eitaro Ito1, Yoshihiko Maehara22, Masaki Honda6, Yukihiro Inomata6, Hiroyuki Furukawa23, Shinji Uemoto2, Hiroki Yamaue24, Masaru Miyazaki25, Tadahiro Takada26. 1. Department of HBP and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan. 2. Division of HBP Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. 3. Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Gunma, Japan. 4. Department of Gastroenterological Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan. 5. Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan. 6. Department of Transplantation and Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Kumamoto, Japan. 7. Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Hokkaido, Japan. 8. Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan. 9. Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Surgical Services, Ageo Central General Hospital, Saitama, Japan. 10. Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Miyagi, Japan. 11. Department of Regenerative Surgery, Fukushima Medical University, Fukushima, Japan. 12. Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan. 13. Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. 14. Artificial Organ and Transplantation Surgery Division, Department of Surgery, The University of Tokyo, Tokyo, Japan. 15. National Hospital Organization Yokohama Medical Center, Kanagawa, Japan. 16. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan. 17. Department of Gastroenterological Surgery, Kanazawa University, Ishikawa, Japan. 18. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. 19. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. 20. Hepato-Biliary-Pancreatic Surgery, Kobe University Hospital, Hyogo, Japan. 21. Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan. 22. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 23. Division of Gastroenterologic Surgery, Department of Surgery, Asahikawa Medical University, Hokkaido, Japan. 24. Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan. 25. International University of Health and Welfare, Mita Hospital, Tokyo, Japan. 26. Japanese Society of Hepato-biliary-Pancreatic Surgery, Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND: In the present study, we conducted a multicenter nationwide survey to investigate the effects of preoperative fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the prediction of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT). METHODS: From 16 Japanese LT centers, data were collected on 182 recipients with HCC who underwent living donor liver transplantation (LDLT) between February 2005 and November 2013. PET-positive status was defined as increased uptake of FDG in the tumor compared to the surrounding non-tumor liver tissue. The median follow-up after LDLT was 54.5 months (range 1-125 months). RESULTS: Postoperative HCC recurrence occurred in 23 patients. Multivariate analysis revealed that exceeding the Milan criteria (MC), alpha-fetoprotein (AFP) level ≥115 ng/ml, and PET-positive status were significant and independent risk factors for recurrence. In the over-MC group, a subgroup of patients with AFP level <115 ng/ml and PET-negative status (n = 22) had a significantly lower 5-year recurrence rate than the other patients (n = 27, 19% vs. 53%, P = 0.019). CONCLUSIONS: These results suggest that preoperative FDG-PET status offers additional information on HCC recurrence risk after LT. Over-MC patients with PET-negative status and lower AFP level may achieve successful outcome comparable to that of within-MC patients.
BACKGROUND: In the present study, we conducted a multicenter nationwide survey to investigate the effects of preoperative fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the prediction of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT). METHODS: From 16 Japanese LT centers, data were collected on 182 recipients with HCC who underwent living donor liver transplantation (LDLT) between February 2005 and November 2013. PET-positive status was defined as increased uptake of FDG in the tumor compared to the surrounding non-tumor liver tissue. The median follow-up after LDLT was 54.5 months (range 1-125 months). RESULTS: Postoperative HCC recurrence occurred in 23 patients. Multivariate analysis revealed that exceeding the Milan criteria (MC), alpha-fetoprotein (AFP) level ≥115 ng/ml, and PET-positive status were significant and independent risk factors for recurrence. In the over-MC group, a subgroup of patients with AFP level <115 ng/ml and PET-negative status (n = 22) had a significantly lower 5-year recurrence rate than the other patients (n = 27, 19% vs. 53%, P = 0.019). CONCLUSIONS: These results suggest that preoperative FDG-PET status offers additional information on HCC recurrence risk after LT. Over-MCpatients with PET-negative status and lower AFP level may achieve successful outcome comparable to that of within-MCpatients.
Authors: Marco Biolato; Giuseppe Marrone; Luca Miele; Antonio Gasbarrini; Antonio Grieco Journal: World J Gastroenterol Date: 2017-05-14 Impact factor: 5.742