Hu Rey-Heng, Ho Ming-Chi, Wu Yao-Ming, Yu Seng-Chang, Lee Po-Huang
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Clin Transplant. 2005 Apr;19(2):175-80. doi: 10.1111/j.1399-0012.2005.00277.x.
Recurrence is the most frequent cause of treatment failure after hepatocellular carcinoma (HCC) resection. Salvage liver transplantation is an alternative treatment for recurrent HCC. The transplantability for patients with recurrent HCC has not been well studied.
This study sought to determine how many patients with recurrent HCC are still candidates for liver transplantation, and to ascertain the possible time from HCC recurrence to the loss of transplantability. In an university hospital setting, 154 of the 252 patients receiving primary HCC resection, from January 1992 through December 1996, had recurrence and were analyzed. The mean follow-up time was 6 years. Among the 154 patients, 74 patients (group 1) were not eligible for liver transplantation according to the Milan criteria, while 80 patients were eligible (group 2). Demographic characteristics of both groups were compared and the curve of transplantability was calculated.
When compared with group 1 patients, group 2 patients displayed more cirrhosis (p = 0.007), lower pTNM stage (p = 0.004), were older (p = 0.004), presented with smaller tumors (p < 0.001), and displayed a longer disease-free interval (p < 0.001). In group 1, only 47% (35/74) patients were eligible for liver transplantation at the time of index hepatectomy, in contrast to 84% (67/80) in the group 2 patients, p < 0.001. The median time from HCC recurrence to the time they were no longer transplantable was 38 months. The total time from the index HCC resection to the time of loss of transplantability was 83 months.
In a cohort of patients after resection for their primary HCC, 33% patients had no recurrence and were not in need for liver transplantation in a mean follow-up of 72 months. About 52% of the patients with recurrent HCC still meet the criteria for liver transplantation. For patients with some certain characteristics, resection of the primary HCC may postpone the time of liver transplantation and prolong the time in which a suitable donor searched, while primary liver transplantation may be considered for those patients with factors of low transplantability after recurrence.
复发是肝细胞癌（HCC）切除术后治疗失败的最常见原因。挽救性肝移植是复发性HCC的一种替代治疗方法。复发性HCC患者的移植可能性尚未得到充分研究。
本研究旨在确定有多少复发性HCC患者仍然是肝移植的候选者，并确定从HCC复发到失去移植可能性的可能时间。在一所大学医院环境中，对1992年1月至1996年12月期间接受原发性HCC切除的252例患者中的154例复发患者进行了分析。平均随访时间为6年。在这154例患者中，74例患者（第1组）根据米兰标准不符合肝移植条件，而80例患者符合条件（第2组）。比较了两组的人口统计学特征并计算了移植可能性曲线。
与第1组患者相比，第2组患者有更多肝硬化（p = 0.007）、更低的pTNM分期（p = 0.004）、年龄更大（p = 0.004）、肿瘤更小（p < 0.001）且无病间期更长（p < 0.001）。在第1组中，仅47%（35/74）的患者在初次肝切除时符合肝移植条件，而第2组患者为84%（67/80），p < 0.001。从HCC复发到不再具有移植可能性的中位时间为38个月。从初次HCC切除到失去移植可能性的总时间为83个月。
在一组原发性HCC切除术后的患者中，33%的患者在平均72个月的随访中未复发且无需肝移植。约52%的复发性HCC患者仍符合肝移植标准。对于具有某些特定特征的患者，原发性HCC切除可能会推迟肝移植时间并延长寻找合适供体的时间，而对于复发后移植可能性低的患者可考虑进行原发性肝移植。
