Fisher R A, Maluf D, Cotterell A H, Stravitz T, Wolfe L, Luketic V, Sterling R, Shiffman M, Posner M
Medical College of Virginia Hospitals/Virginia Commonwealth University Medical Center, Richmond, VA 23298-0254, USA.
Clin Transplant. 2004 Oct;18(5):502-12. doi: 10.1111/j.1399-0012.2004.00196.x.
Orthotopic liver transplantation (OLT) for patients with small hepatocellular carcinoma (HCC) is widely accepted, and the usefulness of local ablation techniques as a bridge for liver transplantation is still under investigation.
From December 1997 to February 2003, patients with cirrhosis and T0-T1-T2-T3 stage HCC received multi-modality ablative therapy (MMT) for the treatment of their HCC and were evaluated for OLT; listed, and transplanted when an allograft became available. MMT included radiofrequency ablation (RFA), and/or Trans-Arterial Chemo-Embolization (TACE), and alcohol (EtOH) ablation, followed by Trans-Arterial Chemo-Infusion (TACI), with repeated treatments based on follow up hepatic magnetic resonance imaging (MRI) during the waiting period for OLT.
A total of 135 HCC patients were seen at our center within this time frame. The intention-to-treat group included 33 (24.4%) patients with T0, T1, T2, T3 HCC and cirrhosis. There were 31 men and two women. The mean age was 53.6 +/- 7.2 yr. All patients received MMT with a mean of 2.90 +/- 1.5 procedures per patient. Tumor-node-metastasis (TNM) stages at time of listing were: T0 in one patient, T1 in nine patients, T2 in 17 patients, and T3 in six patients. Twenty-eight (85%) patients have received OLT. Five (12.19%) patients were listed and removed (dropout) from the transplant waiting list after waiting 5, 5, 5, 8, and 14 months respectively. The waiting time of the HCC listed group was 9.1 +/- 14.8 months with a mean follow up of 32 months. OLT patient survival and cancer-free survival are 92.9% and 95.24%, respectively; the overall survival of intention-to-treat group was 79% at 32 months follow up. Predictors of dropout included an alpha-fetoprotein (AFP, >400 ng/mL) and T3 HCC stage.
Aggressive ablation therapy with a short transplant waiting time optimizes the use of OLT for curative intent in selective cirrhotic HCC patients.
原位肝移植（OLT）治疗小肝细胞癌（HCC）已被广泛接受，局部消融技术作为肝移植桥梁的有效性仍在研究中。
1997年12月至2003年2月，肝硬化合并T0-T1-T2-T3期HCC患者接受多模式消融治疗（MMT）以治疗其HCC，并接受OLT评估；登记入组，当有合适的同种异体肝移植供体时进行移植。MMT包括射频消融（RFA）、和/或经动脉化疗栓塞（TACE）、乙醇（EtOH）消融，随后进行经动脉化疗灌注（TACI），在等待OLT期间根据随访肝脏磁共振成像（MRI）结果进行重复治疗。
在此期间，本中心共诊治135例HCC患者。意向性治疗组包括33例（24.4%）T0、T1、T2、T3期HCC合并肝硬化患者。其中男性31例，女性2例。平均年龄为53.6±7.2岁。所有患者均接受MMT，平均每位患者接受2.90±1.5次治疗。登记时的肿瘤-淋巴结-转移（TNM）分期为：1例T0期，9例T1期，17例T2期，6例T3期。28例（85%）患者接受了OLT。5例（12.19%）患者分别在等待5、5、5、8和14个月后被列入移植等待名单并退出（失访）。列入等待名单的HCC患者等待时间为9.1±14.8个月，平均随访32个月。OLT患者的生存率和无癌生存率分别为92.9%和95.24%；意向性治疗组在随访32个月时的总生存率为79%。失访的预测因素包括甲胎蛋白（AFP，>400 ng/mL）和T3期HCC。
积极的消融治疗和较短的移植等待时间可优化OLT在选择性肝硬化HCC患者中的治愈性应用。
