Decaens Thomas, Roudot-Thoraval Françoise, Hadni-Bresson Solange, Meyer Carole, Gugenheim Jean, Durand Francois, Bernard Pierre-Henri, Boillot Olivier, Sulpice Laurent, Calmus Yvon, Hardwigsen Jean, Ducerf Christian, Pageaux Georges-Philippe, Dharancy Sebastien, Chazouilleres Olivier, Cherqui Daniel, Duvoux Christophe
Service d'Hépatologie et de Gastroentérologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Henri Mondor, Créteil, France.
Liver Transpl. 2006 Dec;12(12):1761-9. doi: 10.1002/lt.20884.
Orthotopic liver transplantation (OLT) indication for hepatocellular carcinoma (HCC) is currently based on the Milan criteria. The University of California, San Francisco (UCSF) recently proposed an expansion of the selection criteria according to tumors characteristics on the explanted liver. This study: 1) assessed the validity of these criteria in an independent large series and 2) tested for the usefulness of these criteria when applied to pre-OLT tumor evaluation. Between 1985 and 1998, 479 patients were listed for liver transplantation (LT) for HCC and 467 were transplanted. According to pre-OLT (imaging at date of listing) or post-OLT (explanted liver) tumor characteristics, patients were retrospectively classified according to both the Milan and UCSF criteria. The 5-yr survival statistics were assessed by the Kaplan-Meier method and compared by the log-rank test. Pre-OLT UCSF criteria were analyzed according to an intention-to-treat principle. Based on the pre-OLT evaluation, 279 patients were Milan+, 44 patients were UCSF+ but Milan- (subgroup of patients that might benefit from the expansion), and 145 patients were UCSF- and Milan-. With a short median waiting time of 4 months, 5-yr survival was 60.1 +/- 3.0%, 45.6 +/- 7.8%, and 34.7 +/- 4.0%, respectively (P < 0.001). The 5-yr survival was arithmetically lower in UCSF+ Milan- patients compared to Milan+ but this difference was not significant (P = 0.10). Based on pathological features of the explanted liver, 5-yr survival was 70.4 +/- 3.4%, 63.6 +/- 7.8%, and 34.1 +/- 3.1%, in Milan+ patients (n = 184), UCSF+ Milan- patients (n = 39), and UCSF- Milan- patients (n = 238), respectively (P < 0.001). However, the 5-yr survival did not differ between Milan+ and UCSF+ Milan- patients (P = 0.33). In conclusion, these results show that when applied to pre-OLT evaluation, the UCSF criteria are associated with a 5-yr survival below 50%. Their applicability is therefore limited, despite similar survival rates compared to the Milan criteria, when the explanted liver is taken into account.
肝细胞癌（HCC）的原位肝移植（OLT）指征目前基于米兰标准。加利福尼亚大学旧金山分校（UCSF）最近根据移植肝上肿瘤的特征提议扩大选择标准。本研究：1）在一个独立的大样本系列中评估这些标准的有效性，2）测试这些标准应用于OLT前肿瘤评估时的实用性。1985年至1998年期间，479例因HCC列入肝移植（LT）名单，467例接受了移植。根据OLT前（列入名单时的影像学检查）或OLT后（移植肝）肿瘤特征，患者按照米兰标准和UCSF标准进行回顾性分类。采用Kaplan-Meier法评估5年生存率，并通过对数秩检验进行比较。根据意向性治疗原则分析OLT前的UCSF标准。基于OLT前评估，279例患者符合米兰标准，44例患者符合UCSF标准但不符合米兰标准（可能从扩大标准中受益的患者亚组），145例患者既不符合UCSF标准也不符合米兰标准。中位等待时间较短，为4个月，5年生存率分别为60.1±3.0%、45.6±7.8%和34.7±4.0%（P<0.001）。符合UCSF标准但不符合米兰标准的患者5年生存率在算术上低于符合米兰标准的患者，但差异无统计学意义（P = 0.10）。根据移植肝的病理特征，符合米兰标准的患者（n = 184）、符合UCSF标准但不符合米兰标准的患者（n = 39）和既不符合UCSF标准也不符合米兰标准的患者（n = 238）的5年生存率分别为70.4±3.4%、63.6±7.8%和34.1±3.1%（P<0.001）。然而，符合米兰标准和符合UCSF标准但不符合米兰标准的患者5年生存率无差异（P = 0.33）。总之，这些结果表明，当应用于OLT前评估时，UCSF标准与5年生存率低于50%相关。因此，尽管与米兰标准相比生存率相似，但考虑移植肝时其适用性有限。
