Yokoi Hajime, Isaji Shuji, Yamagiwa Kentaro, Tabata Masami, Nemoto Akiyoshi, Sakurai Hiroyuki, Usui Mosanobu, Uemoto Shinji
First Department of Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
J Hepatobiliary Pancreat Surg. 2006;13(2):123-30. doi: 10.1007/s00534-005-1018-8.
BACKGROUND/PURPOSE: The role of living-donor liver transplantation (LDLT) in the surgical treatment of patients with hepatocellular carcinoma (HCC) has not been established as yet.
Preliminary experience gained from 24 patients who underwent LDLT for HCC between March 2002 and November 2004, and the results of the 131 patients who underwent hepatic resection (HR) for HCC between January 1990 and December 2003 were retrospectively analyzed. The exclusion criteria for LDLT for HCC included extrahepatic metastasis and major vascular invasion.
(1) LDLT: the median age of the patients was 57 years and the Child-Pugh grades (A/B/C) of the patients were 6, 12, and 6, respectively. The tumor size was 3 cm or less in 15 patients, multinodular tumors were present in 23 patients, and 11 patients (45.8%) met the Milan Criteria. The overall 2-year survival rate was 72.3%, without a significant difference as to whether or not patients met the Milan criteria. (2) HR: on multivariate analysis, the Child-Pugh grade, the presence of cirrhosis, and the number of tumor nodules were considered as independent risk factors for unfavorable survival (P < 0.05). The 84 patients who met the Milan criteria and were Child-Pugh grade A had a 5-year survival rate of 71.3%; this was significantly better than those of the other patients (P < 0.005). Among the 57 patients with intrahepatic recurrence, 18 patients who were Child-Pugh grade A, met the Milan criteria, and were treated by re-resection or ablation therapy achieved a significantly better 5-year survival rate, of 73.1%, as compared to 19.7% in the other 39 patients (P < 0.0045).
HR could be a first-line treatment with a favorable prognosis for patients who have resectable HCC, preserved liver function, and who meet the Milan criteria. Salvage LDLT could be employed in patients with recurrent tumors that cannot be controlled by conventional treatment or in patients in whom liver function has deteriorated to Child-Pugh grade B or C.
背景/目的：活体肝移植（LDLT）在肝细胞癌（HCC）患者外科治疗中的作用尚未确定。
回顾性分析2002年3月至2004年11月期间24例行LDLT治疗HCC患者的初步经验，以及1990年1月至2003年12月期间131例行肝切除术（HR）治疗HCC患者的结果。HCC行LDLT的排除标准包括肝外转移和主要血管侵犯。
（1）LDLT：患者中位年龄57岁，Child-Pugh分级（A/B/C）分别为6例、12例和6例。15例患者肿瘤大小为3 cm或更小，23例患者存在多结节肿瘤，11例患者（45.8%）符合米兰标准。总体2年生存率为72.3%，患者是否符合米兰标准无显著差异。（2）HR：多因素分析显示，Child-Pugh分级、肝硬化的存在以及肿瘤结节数量被视为生存不良的独立危险因素（P<0.05）。84例符合米兰标准且Child-Pugh分级为A级的患者5年生存率为71.3%；这显著优于其他患者（P<0.005）。在57例肝内复发患者中，18例Child-Pugh分级为A级、符合米兰标准且接受再次切除或消融治疗的患者5年生存率显著更高，为73.1%，而其他39例患者为19.7%（P<0.0045）。
对于可切除的HCC、肝功能良好且符合米兰标准的患者，HR可能是一线治疗方法，预后良好。挽救性LDLT可用于常规治疗无法控制的复发性肿瘤患者或肝功能已恶化为Child-Pugh B级或C级的患者。
