Ravaioli Matteo, Grazi Gian Luca, Ercolani Giorgio, Fiorentino Michelangelo, Cescon Matteo, Golfieri Rita, Trevisani Franco, Grigioni Walter Franco, Bolondi Luigi, Pinna Antonio Daniele
Department of Liver and Multi-organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy.
Transplantation. 2004 Dec 27;78(12):1780-6. doi: 10.1097/01.tp.0000145892.97114.ee.
The presence of partial necrosis in hepatocellular carcinoma (HCC) nodules is a common histologic finding after liver transplantation, but its correlation with tumor recurrence has never been investigated.
we retrospectively reviewed the outcome of 54 patients with a single histologically proven HCC after liver transplantation. All cases had a survival of more than 6 months, and patients treated preoperatively had a transarterial chemoembolization (TACE) procedure. Since 1996, our center has applied the Milan criteria. Correlations between tumor recurrences and clinicopathologic variables, including the presence of partial necrosis, were performed. Etiologic factors for HCC partial necrosis were also investigated.
Sixteen of 54 (29.6%) HCC nodules presented partial necrosis, and 4 (25%) of them developed HCC recurrence compared with 1 of 38 (2.6%) cases without this histologic finding (P<0.05). Partial necrosis was related to TACE procedure (P<0.05), patient age less than 50 years (P<0.05), and tumor diameter greater than 2 cm (P<0.05). Multivariate analysis showed only TACE as an independent variable. The other variables related to the five (9.3%) tumor recurrences were HCC diameter greater than 2 cm (P<0.05), year of liver transplantation before 1996 (P<0.05), and the presence of satellite nodules (P<0.05). The Cox regression analysis showed the presence of partial necrosis as an independent variable related to tumor recurrence. The analysis of the recurrence-free survival confirmed the results of the recurrence rate.
Partial necrosis was a risk factor for tumor recurrence after liver transplantation. Patients and procedures should be selected while also bearing in mind the side-effect of incomplete necrosis of the nodules.
肝细胞癌（HCC）结节中存在部分坏死是肝移植后常见的组织学表现，但其与肿瘤复发的相关性尚未得到研究。
我们回顾性分析了54例肝移植后经组织学证实为单发HCC患者的预后。所有病例生存期均超过6个月，术前接受过经动脉化疗栓塞（TACE）治疗。自1996年以来，我们中心采用米兰标准。对肿瘤复发与临床病理变量之间的相关性进行了分析，包括部分坏死的存在情况。还研究了HCC部分坏死的病因。
54个HCC结节中有16个（29.6%）出现部分坏死，其中4个（25%）发生了HCC复发，而38个无此组织学表现的病例中只有1个（2.6%）复发（P<0.05）。部分坏死与TACE治疗（P<0.05）、患者年龄小于50岁（P<0.05）以及肿瘤直径大于2 cm（P<0.05）有关。多因素分析显示只有TACE是独立变量。与5例（9.3%）肿瘤复发相关的其他变量包括HCC直径大于2 cm（P<0.05）、1996年前进行肝移植（P<0.05）以及存在卫星结节（P<0.05）。Cox回归分析显示部分坏死的存在是与肿瘤复发相关的独立变量。无复发生存分析证实了复发率的结果。
部分坏死是肝移植后肿瘤复发的危险因素。在选择患者和治疗方法时，应同时考虑结节不完全坏死的副作用。
