Shah Shimul A, Cleary Sean P, Tan Jensen C C, Wei Alice C, Gallinger Steve, Grant David R, Greig Paul D
Department of Surgery, University Health Network, University of Toronto, Toronto, Canada.
Ann Surg Oncol. 2007 Sep;14(9):2608-14. doi: 10.1245/s10434-007-9443-3. Epub 2007 May 24.
The reported survival after liver transplantation (OLT) for early hepatocellular carcinoma (HCC) is superior to the results of liver resection (LR), but few analyses have considered long waiting times and patient drop-offs due to tumor progression.
From 1995-2005, 347 patients with HCC were evaluated at our institution and underwent either LR (n = 174) or placed on the OLT waiting list (n = 173). Patients who only underwent ablation were not included. After eliminating patients with 1) incidental tumors after OLT, 2) tumors outside of Milan criteria, 3) preoperative vascular invasion prior to LR and 4) Child-Pugh Class C cirrhosis prior to OLT, 261 patients (LR = 121; OLT = 140) were included in this analysis.
Median follow-up time was 35 months. Median waiting time for OLT was 7.7 months; during this time, 30 patients were taken off the waiting list. Overall survival (OS) from time of listing or LR was not different between the two groups; 1, 3, and 5 year OS after LR was 89%, 75%, and 56% compared with 90%, 70%, and 64% for OLT (P = .84). Only patients who waited <4 months for OLT (n = 67) had better survival than those who underwent LR (P = .05). Patients who waited longer that four months for OLT had a 2.5x higher risk of death in a Cox multivariate model [odds ratio (OR) 2.5; 95% confidence interval (CI): 1.3-5; P = .007].
Unless waiting time is short (< 4 months), the survival of patients with early HCC is similar between LR and LT.
据报道，早期肝细胞癌（HCC）肝移植（OLT）后的生存率优于肝切除术（LR），但很少有分析考虑到长时间等待和因肿瘤进展导致的患者退出情况。
1995年至2005年期间，在我们机构对347例HCC患者进行了评估，这些患者要么接受了LR（n = 174），要么被列入OLT等待名单（n = 173）。仅接受消融治疗的患者未纳入。在排除1）OLT术后偶然肿瘤患者、2）超出米兰标准的肿瘤患者、3）LR术前血管侵犯患者以及4）OLT术前Child-Pugh C级肝硬化患者后，本分析纳入了261例患者（LR = 121；OLT = 140）。
中位随访时间为35个月。OLT的中位等待时间为7.7个月；在此期间，30例患者被从等待名单中移除。两组从列入名单或LR时间起的总生存率（OS）无差异；LR术后1年、3年和5年的OS分别为89%、75%和56%，而OLT分别为90%、70%和64%（P = 0.84）。仅OLT等待时间<4个月的患者（n = 67）的生存率高于接受LR的患者（P = 0.05）。在Cox多变量模型中，OLT等待时间超过4个月的患者死亡风险高2.5倍[比值比（OR）2.5；95%置信区间（CI）：1.3 - 5；P = 0.007]。
除非等待时间短（<4个月），早期HCC患者LR和LT后的生存率相似。
