Khakhar A, Solano E, Stell D, Bloch M, Dale C, Burns P, Ghent C, Quan D, McAlister V, Marotta P, Wall W J
Multiorgan Transplant Program, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
Transplant Proc. 2003 Nov;35(7):2438-41. doi: 10.1016/j.transproceed.2003.08.018.
Selection criteria for patients with hepatocellular carcinoma (HCC) suitable for liver transplantation (LT) include tumor size and number and vascular invasion. There has been a recent trend to expand the transplant criteria for HCC. We reviewed our experience to determine survival following LT based on tumor characteristics.
A retrospective analysis was performed on 72 patients with HCC who underwent LT between 1985 and July 2002. The Milan criteria were applied for LT candidacy for HCCs that were deemed unresectable from anatomical considerations and/or the severity of underlying cirrhosis. Patients were divided into four groups: group 1: patients with known HCC who satisfied the selection criteria (n = 22); group 2: patients with known HCC that exceeded the criteria (n = 17); group 3: patients with incidental HCC found at pathological examination of the explant (n = 33); group 4: contemporary LT recipients without HCC (n = 935).
In the known HCC group, the interval between listing as status 2 and transplantation was 72.2 +/- 133.6 days (median 23 days). Three-year patient survival was 80.2% in group 1, 35.8% in group 2, 63.2% in group 3, and 81.5% in group 4. In group 2 patients, the tumors were significantly larger, had more nodules, and were more often bilobar. In group 3, five (15%) exceeded the criteria mainly because of tumor size and four patients died within 3 years post-LT (three from tumor recurrence).
Liver transplantation for HCC yields acceptable survival in early-stage tumors, particularly if transplanted soon after listing. Long-term survival was inferior in patients with multiple tumors and tumors that were greater than 5 cm in diameter.
适合肝移植（LT）的肝细胞癌（HCC）患者的选择标准包括肿瘤大小、数量和血管侵犯情况。最近有扩大HCC移植标准的趋势。我们回顾了我们的经验，以确定基于肿瘤特征的LT后的生存率。
对1985年至2002年7月期间接受LT的72例HCC患者进行回顾性分析。对于因解剖学考虑和/或潜在肝硬化的严重程度而被认为无法切除的HCC，应用米兰标准作为LT候选标准。患者分为四组：第1组：符合选择标准的已知HCC患者（n = 22）；第2组：已知HCC超过标准的患者（n = 17）；第3组：在移植肝病理检查中发现的偶然HCC患者（n = 33）；第4组：当代无HCC的LT受者（n = 935）。
在已知HCC组中，从列为2级状态到移植的间隔时间为72.2±133.6天（中位数23天）。第1组患者3年生存率为80.2%，第2组为35.8%，第3组为63.2%，第4组为81.5%。在第2组患者中，肿瘤明显更大，结节更多，且更常为双侧。在第3组中，5例（15%）超过标准主要是因为肿瘤大小，4例患者在LT后3年内死亡（3例死于肿瘤复发）。
HCC肝移植在早期肿瘤中可获得可接受的生存率，特别是在列入名单后不久进行移植。多肿瘤和直径大于5 cm的肿瘤患者的长期生存率较低。
