[肝细胞癌肝移植指征：上海复旦标准]

[Indication of liver transplantation for hepatocellular carcinoma: Shanghai Fudan Criteria].

作者信息

Fan Jia, Zhou Jian, Xu Yang, Qiu Shuang-jian, Wu Zhi-quan, Yu Yao, Huang Xiao-wu, Tang Zhao-you, Wang Yu-qi

机构信息

Department of Liver Surgery & Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China.

出版信息

Zhonghua Yi Xue Za Zhi. 2006 May 16;86(18):1227-31.

PMID:16796876

Abstract

OBJECTIVE

To evaluate the effects of different selection criteria on the prognosis of hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) and to explore the new criteria adapted for Chinese National Situation.

METHODS

A retrospective analysis was performed on 251 consecutive patients with HCC who underwent LT between April 2001 and January 2006 at our institution. We compared the outcome of the patients meeting different criteria such as milan, UCSF and the Pittsburgh modified TNM criteria. Survival rates were calculated using the Kaplan-Meier method, and differences between the curves were assessed by log-rank test.

RESULTS

There was no significant difference in 1, 2, 3-year survival rates and recurrence-free survival rates between milan criteria (n = 93; 86%, 77%, 77% and 91%, 86%, 86%) and UCSF criteria (n = 131; 90%, 83%, 83% and 92%, 89%, 89%). According to Pittsburgh criteria (n = 207), the 1, 2, 3-year survival rates and recurrence-free survival rates were 84%, 74%, 67% and 85%, 83%, 73%, respectively. For advanced tumors (over all the criteria), the survival rates and recurrence-free survival rates decreased significantly (n = 44; 65%, 43%, 43% and 47%, 43%, 43% respectively). When criteria (named as Shanghai Fudan Criteria) were expanded to HCC patients with solitary lesions < or = 9 cm in diameter, or no more than 3 lesions, the largest < or = 5 cm, with a total tumor diameter < or = 9 cm, there was no significant difference in 1, 2, 3-year survival rates and recurrence-free survival rates (n = 151; 88%, 80%, 80% and 90%, 88%, 88%, respectively) as compared with milan criteria, but more patients using Shanghai Fudan Criteria could undergo liver transplantation.

CONCLUSION

Shanghai Fudan Criteria, which expanded the tumor size limits, does not adversely impact survival of HCC patients after LT.

摘要

目的

评估不同选择标准对接受肝移植（LT）的肝细胞癌（HCC）患者预后的影响，并探索适合中国国情的新标准。

方法

对2001年4月至2006年1月在我院连续接受LT的251例HCC患者进行回顾性分析。我们比较了符合不同标准（如米兰标准、加州大学旧金山分校（UCSF）标准和匹兹堡改良TNM标准）的患者的预后。采用Kaplan-Meier法计算生存率，通过对数秩检验评估曲线之间的差异。

结果

米兰标准组（n = 93；1年、2年、3年生存率及无复发生存率分别为86%、77%、77%和91%、86%、86%）与UCSF标准组（n = 131；1年、2年、3年生存率及无复发生存率分别为90%、83%、83%和92%、89%、89%）在1年、2年、3年生存率及无复发生存率方面无显著差异。根据匹兹堡标准（n = 207），1年、2年、3年生存率及无复发生存率分别为84%、74%、67%和85%、83%、73%。对于晚期肿瘤（超过所有标准），生存率及无复发生存率显著下降（n = 44；分别为65%、43%、43%和47%、43%、43%）。当标准（命名为上海复旦标准）扩大到直径≤9 cm的孤立性病变或不超过3个病变、最大直径≤5 cm且肿瘤总直径≤9 cm的HCC患者时，与米兰标准相比，1年、2年、3年生存率及无复发生存率无显著差异（n = 151；分别为88%、80%、80%和90%、88%、88%），但采用上海复旦标准可使更多患者接受肝移植。