Roayaie Sasan, Schwartz Jonathan D, Sung Max W, Emre Sukru H, Miller Charles M, Gondolesi Gabriel E, Krieger Nancy R, Schwartz Myron E
Recanati-Miller Transplantation Institute, Department of Medicine, Mount Sinai Medical Center, Mount Sinai-NYU Health System, New York, NY 10029, USA.
Liver Transpl. 2004 Apr;10(4):534-40. doi: 10.1002/lt.20128.
Very little is known about the natural history, effects of therapy, and survival after recurrence of hepatocellular carcinoma (HCC) after liver transplantation. All adult patients undergoing liver transplant from September 19, 1988, until September 19, 2002, were reviewed. Only patients with histologically proven HCC in the explant who subsequently developed recurrence were included in further analysis. The endpoints analyzed were survival from time of transplant and survival from time of recurrence. Recipient demographics and laboratory values, technique of transplant (whole cadaver, split, or living donor), and tumor characteristics were analyzed. The time to, location of, and any medical or surgical treatment of recurrences also were considered. Of the 311 patients with HCC in the explant, 57 (18.3%) eventually were diagnosed with recurrent tumor after transplant. Median time to recurrence was 12.3. Five-year survival was significantly lower for patients with recurrence (22%) than for patients without recurrence (64%)(P < 0.0001). Multivariate analysis demonstrated that the size and differentiation of the original tumor, as well as the presence of bone recurrence, were independently associated with survival from transplant in patients with recurrence. When survival from the time of recurrence was analyzed, multivariate analysis showed that the absence of bone metastases, recurrence more than 12 months from transplant, and surgical treatment of the recurrence were independently associated with significantly longer survival. In conclusion, recurrence of HCC significantly shortens survival after transplant. Nonetheless, some patients with recurrence can be expected to live for a considerable period of time. Recurrent disease should be treated surgically when possible, because surgery is independently associated with longer survival.
关于肝移植后肝细胞癌（HCC）的自然病史、治疗效果及复发后的生存率，人们了解甚少。我们回顾了1988年9月19日至2002年9月19日期间所有接受肝移植的成年患者。仅纳入肝移植切除标本经组织学证实为HCC且随后发生复发的患者进行进一步分析。分析的终点指标为移植后生存时间和复发后生存时间。对受者的人口统计学特征和实验室检查值、移植技术（全尸肝、劈离式或活体供肝）以及肿瘤特征进行了分析。还考虑了复发的时间、部位以及任何内科或外科治疗情况。在311例肝移植切除标本中有HCC的患者中，57例（18.3%）最终被诊断为移植后肿瘤复发。复发的中位时间为12.3个月。复发患者的5年生存率（22%）显著低于未复发患者（64%）（P<0.0001）。多因素分析表明，原肿瘤的大小和分化程度以及骨转移的存在与复发患者移植后的生存独立相关。在分析复发后的生存情况时，多因素分析显示无骨转移、移植后12个月以上复发以及对复发进行手术治疗与显著更长的生存期独立相关。总之，HCC复发显著缩短移植后的生存期。尽管如此，一些复发患者仍有望存活相当长一段时间。复发疾病应尽可能进行手术治疗，因为手术与更长的生存期独立相关。
