Liver transplantation for hepatocellular carcinoma： is zero recurrence theoretically possible？

BACKGROUND： Hepatocellular carcinoma（HCC） recurrence remains a key issue after liver transplantation. This study aimed to determine a subgroup of HCC patients within the Milan criteria who could achieve a theoretical goal of zero recurrence rates after liver transplantation.METHODS： Between 1999 and 2009, 179 patients who received liver transplantation for HCC within the Milan criteria were retrospectively included. Analysis of the factors associated with HCC recurrence was performed to determine the subgroup of patients at the lowest risk of recurrence.RESULTS： Seventy-two percent of the patients received a bridging therapy, including 54 liver resections. Eleven（6.1%） patients recurred within a delay of 19±22 months and ultimately died. Factors associated with recurrence were serum alpha-fetoprotein level 〉400 ng/m L, satellite nodules, poor differentiation, microvascular invasion and cholangiocarcinoma component. Recurrence rates decreased from 6.1% to 3.1% in patients without any of these factors.CONCLUSIONS： Among HCC patients within the Milan criteria, selecting patients with factors based on histology would allow tending towards zero recurrence, and prior histological assessment by liver biopsy or resection may be essential to rule out poorly differentiated tumors, microvascular invasion,and cholangiocarcinoma component.

Clinical use of hepatic carcinoma associated membrane protein antigen (HAg18-1) as reagent of enzyme linked immunosorbent assay for detection of primary hepatocellular carcinoma

AIMS To evaluate the sensitivity,specificity and clinical value of hepatic carcinoma associated mem- brane protein antigen (HAg18-1) used as a reagent of serum quick enzyme linked immunosorbent assay (ELISA) for the detection of primary hepatocellular car- cinoma (PHCC). METHODS Serum quick enzyme linked immunosor- bent assay (ELISA) with HAg18-1 as reagent,which was prepared by monoclonal antibody against human hepatic carcinoma,was performed on 100 cases of pri- mary hepatocellular carcinoma (PHCC),5 cases of hepatic biliary carcinoma (HBC),10 cases of metastatic hepatic carcinoma (MHC),20 cases of hep- atitis B (HB),20 cases of liver cirrhosis (LC),20 cas- es of gastrointestinal malignant tumours and 20 cases of gastronintestinal inflammatory diseases (including ulcers). Alpha-fetoprotein (AFP) detection concurrent- ly for each case. Twenty samples of bank blood were tested as controls. RESULTS Positive rate of HAg18-1 ELISA and AFP detection were 81% and 68% in PHCC,20% and 40% in HBC,19% and 20% in MHC,10% and 20% in BH, 10% and 20% in LC,10% and 15% in gastrointestinal malignant tumors,and 5% and 10% in gastrointestinal inflammatory diseases. No positive result of HAg18-1 ELISA and AFP detection occurred in any sample of bank blood. CONCLUSIONS HAg18-1 ELISA has high sensitivity and specificity in the detection of PHCC. HAg18-1 ELISA and AFP detection,if used together,may be complementary to each other in the diagnosis of PHCC.