Living donor liver transplantation for hepatocellular carcinoma: a special reference to a preoperative des-gamma-carboxy prothrombin value.
BACKGROUND
Des-gamma-carboxy prothrombin (DCP) is a sensitive marker related to vascular invasion of hepatocellular carcinoma (HCC). The aim of this study was to clarify the risk factors of HCC recurrence in living donor liver transplantation (LDLT) with special reference to preoperative DCP values.


METHODS
Forty consecutive adult HCC patients who underwent LDLT were examined for a correlation between the DCP value and vascular invasion. Risk factors for recurrence were also investigated using clinicopathological variables including preoperative DCP levels.


RESULTS
The incidence of positive histological vascular invasion in patients with DCP values above 300 mAU/mL was higher than that with those with DCP value below 300 mAU/mL. Other significant risk factors for recurrence were over 5 cm tumor diameter, not meeting the Milan criteria, AFP value >400 ng/mL, histological vascular invasion, poorly differentiated histology, and male gender. Among the patients who did not meet the Milan criteria, those with both no more than 5 cm of tumor diameter and no more than 300 mAU/mL DCP exhibited a good prognosis.


CONCLUSIONS
A high DCP value, namely >300 mAU/mL correlated with histological vascular invasion and was one of the strongest prognostic variables. Therefore, special attention should be paid to HCC patients with high DCP values. No correlation between the number of tumor nodules and recurrence was found; therefore, the Milan criteria may require revision regarding the number of tumor nodules.
Shimada
M
M
Department of Digestive and Pediatric Surgery, Institute of Health Bioscience, University of Tokushima Graduate School, Tokushima, Japan. mshimada@clin.med.tokushima-u.ac.jp
Yonemura
Y
Y
Ijichi
H
H
Harada
N
N
Shiotani
S
S
Ninomiya
M
M
Terashi
T
T
Yoshizumi
T
T
Soejima
Y
Y
Maehara
Y
Y
D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D003565:Cytidine Diphosphate / Q000032:analysis*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011517:Prothrombin Time; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
D014408:Biomarkers, Tumor; D003565:Cytidine Diphosphate