Marui Yuhji, McCall John, Gane Edward, Holden Andrew, Duncan David, Yeong Mee-Ling, Chow Kai, Munn Stephen
New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.
N Z Med J. 2005 Jun 24;118(1217):U1532.
Liver transplantation (LT) is potentially curative for early hepatocellular carcinoma (HCC) but time spent on the waiting list exposes patients to the risk of tumour progression prior to transplantation.
We prospectively evaluated the outcome for New Zealand patients listed for LT with a pre-transplant diagnosis of HCC.
Patients with 1 to 3 tumours, up to 5 cm in diameter, and no vascular invasion or extra-hepatic disease on imaging, were considered eligible for LT. The results were analysed by intention to treat from the time of listing.
Fifty-nine patients were listed with a pre-transplant diagnosis of HCC between February 1998 and June 2004. Ten (17%) were de-listed before LT because of tumour progression, and 9 of 45 (20%) who underwent LT have experienced tumour recurrence up to 59 months post-transplant. For patients listed with a diagnosis of HCC, 5-year actuarial survival was 56.1% from the time of listing. For those listed and transplanted with a diagnosis of HCC, 5-year actuarial survival from the time of transplant was 63.5%. This is significantly worse than the 89.8% 5-year survival for patients transplanted without HCC over the same period (p=0.018) and this difference was entirely due to tumour recurrence.
37% of patients listed according to our criteria were either de-listed due to tumour progression or experienced recurrence after LT. Based on this experience strategies aimed at preventing waiting list drop out have been adopted, however expansion of tumour-related selection criteria cannot be recommended without a concomitant increase in donor organ availability.
肝移植（LT）对早期肝细胞癌（HCC）可能具有治愈性，但在等待名单上花费的时间使患者面临移植前肿瘤进展的风险。
我们前瞻性评估了新西兰接受肝移植且移植前诊断为HCC患者的结局。
直径达5厘米、有1至3个肿瘤且影像学检查无血管侵犯或肝外疾病的患者被认为符合肝移植条件。从列入名单之时起按意向性治疗分析结果。
1998年2月至2004年6月期间有59例患者在移植前诊断为HCC并被列入名单。10例（17%）因肿瘤进展在肝移植前被取消名单，45例接受肝移植的患者中有9例（20%）在移植后长达59个月出现肿瘤复发。对于诊断为HCC而被列入名单的患者，从列入名单之时起5年精算生存率为56.1%。对于诊断为HCC而被列入名单并接受移植的患者，从移植之时起5年精算生存率为63.5%。这明显低于同期无HCC接受移植患者的89.8%的5年生存率（p = 0.018），且这种差异完全是由于肿瘤复发。
根据我们的标准列入名单的患者中有37%要么因肿瘤进展被取消名单，要么在肝移植后出现复发。基于这一经验，已采取旨在防止从等待名单中退出的策略，然而，在供体器官可获得性未随之增加的情况下，不建议扩大与肿瘤相关的选择标准。
