C-reactive protein is an independent predictor for hepatocellular carcinoma recurrence after liver transplantation

BackgroundSerum C-reactive protein (CRP) is a prognostic factor for overall survival (OS) and recurrence of hepatocellular carcinoma (HCC) in patients treated with resection or non-surgical treatment. Here, we investigated the association of elevated CRP (≥1 vs. MethodsAdult HCC patients undergoing orthotopic deceased donor LT at the Medical University of Vienna between 1997 and 2014 were retrospectively analysed.ResultsAmong 216 patients included, 132 (61.1%) were transplanted within the Milan criteria and forty-two patients (19.4%) had microvascular invasion on explant histology. Seventy patients (32.4%) showed elevated CRP (≥ 1 mg/dL). On multivariate analysis, a CRP ≥ 1 mg/dL was an independent risk factor for HCC recurrence with a 5-year recurrence rate of 27.4% vs. 16.4% (HR 2.33; 95% CI 1.13–4.83; p = 0.022). OS was similar in patients with normal vs. elevated CRP levels.ConclusionsElevated serum CRP is associated with HCC recurrence after LT and may be a marker for more aggressive tumor biology. Future studies should evaluate whether patients with elevated pre-transplant CRP levels benefit from closer monitoring for HCC recurrence.【背景】血清C反应蛋白（serum C-reactive protein，CRP）是接受手术切除或非手术治疗的肝细胞癌（hepatocellular carcinoma，HCC）患者总生存期（overall survival，OS）与复发风险的预后影响因素。本研究旨在探讨术前血清CRP升高（≥1mg/dL，以<1mg/dL为对照）与肝移植（liver transplantation，LT）术后HCC复发及预后的关联。 【方法】本研究回顾性分析了1997年至2014年间在维也纳医科大学接受原位尸体供肝移植的成人HCC患者临床资料。 【结果】本研究共纳入216例患者，其中132例（61.1%）符合米兰标准（Milan criteria）并接受移植，42例（19.4%）的移植肝切除标本组织病理学检查显示存在微血管侵犯（microvascular invasion）。70例患者（32.4%）术前血清CRP水平≥1mg/dL。多变量分析（multivariate analysis）结果显示，CRP≥1mg/dL是HCC复发的独立危险因素：CRP升高组的5年复发率为27.4%，而CRP水平正常组为16.4%（风险比HR=2.33，95%置信区间（95% CI）：1.13~4.83，P=0.022）。两组患者的总生存期无显著差异。 【结论】术前血清CRP升高与肝移植术后HCC复发显著相关，可作为肿瘤生物学行为更具侵袭性的潜在标志物。未来的研究可进一步评估术前CRP水平升高的患者是否能从更密切的HCC复发监测中获益。