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原发性硬化性胆管炎的肝移植;肝胆恶性肿瘤的预测因素及后果

Liver transplantation for primary sclerosing cholangitis; predictors and consequences of hepatobiliary malignancy.

作者信息

Brandsaeter B, Isoniemi Helena, Broomé Ulrika, Olausson Michael, Bäckman Lars, Hansen Bent, Schrumpf Erik, Oksanen Antti, Ericzon Bo-Göran, Höckerstedt Krister, Mäkisalo Heikki, Kirkegaard Preben, Friman Styrbjörn, Bjøro Kristian

机构信息

Section of Hepatology and Gastroentrology, Department of Medicine, Rikshospitalet, 0027 Oslo, Norway.

出版信息

J Hepatol. 2004 May;40(5):815-22. doi: 10.1016/j.jhep.2004.01.002.

Abstract

BACKGROUND/AIMS: Hepatobiliary malignancies are frequently seen in primary sclerosing cholangitis (PSC) and they complicate the evaluation of patients and timing of liver transplantation.

METHODS

Data from all Nordic PSC patients listed for liver transplantation during 1990-2001 were recorded prospectively. Predictors of hepatobiliary malignancy and patient survival rates have been analysed.

RESULTS

Hepatobiliary malignancy was found in 52/255 (20%) patients accepted to the waiting list. Recent diagnosis of PSC, no ursodeoxycholic acid (UDCA) treatment, clinical suspicion and previous colorectal-cancer were predictors of malignancy. Among 89 patients with a strong suspicion of malignancy prior to acceptance, 35 (39%) had confirmed malignancy. A clinical suspicion had been raised in 35/52 (67%) patients with malignancy. Malignancy was found in 31/223 patients who received a liver allograft. The 1-, 3- and 5-year patient survival rates following transplantation for patients with PSC and cholangiocarcinoma were 65, 35 and 35%, respectively.

CONCLUSIONS

Hepatobiliary malignancy is suspected in 1/3 of the PSC patients and found in 1/5. Although cholangiocarcinoma is regarded as a contraindication to liver transplantation (LTX), PSC patients with cholangiocarcinoma had a 35% 5-year survival following transplantation.

摘要

背景/目的:肝胆恶性肿瘤在原发性硬化性胆管炎(PSC)中很常见,这使得患者评估和肝移植时机变得复杂。

方法

前瞻性记录了1990年至2001年期间所有列入肝移植等待名单的北欧PSC患者的数据。分析了肝胆恶性肿瘤的预测因素和患者生存率。

结果

在255名被列入等待名单的患者中,有52名(20%)发现了肝胆恶性肿瘤。近期诊断为PSC、未接受熊去氧胆酸(UDCA)治疗、临床怀疑以及既往有结直肠癌是恶性肿瘤的预测因素。在89名接受前高度怀疑恶性肿瘤的患者中,35名(39%)确诊为恶性肿瘤。52名恶性肿瘤患者中有35名(67%)曾被临床怀疑。在接受肝移植的223名患者中,有31名发现了恶性肿瘤。PSC合并胆管癌患者移植后的1年、3年和5年生存率分别为65%、35%和35%。

结论

三分之一的PSC患者怀疑有肝胆恶性肿瘤,五分之一的患者被确诊。尽管胆管癌被视为肝移植(LTX)的禁忌证,但PSC合并胆管癌的患者移植后5年生存率为35%。

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