Urahashi Taizen, Lynch Stephen V, Kim Young Hoon, Balderson Glenda A, Fawcett Jonathan W, Crawford Darryl H, Strong Russell W
Queensland Liver Transplant Service, Princess Alexandra Hospital, Brisbane, Australia.
Hepatogastroenterology. 2007 Jun;54(76):1192-5.
BACKGROUND/AIMS: The aim of the study was to define the clinical characteristics and outcome of patients found to have undetected hepatocellular carcinomas (HCC) at liver transplantation. Patients who underwent liver transplantation and were unexpectedly found to have a HCC despite prior workup showing normal alpha-fetoprotein levels and/or no visible radiological lesion were defined as having an undetected HCC.
Thirty-two of these patients had a histological diagnosis of HCC in the explanted liver. Undetected HCC was defined as a carcinoma found only on pathological evaluation of the explanted liver, with a pre-OLT workup showing a normal serum alpha-fetoprotein (AFP) level (<20 ng/mL) and/or no suspicious lesion on preoperative radiological evaluation.
Nine patients had a tumor that met the criteria for an undetected HCC. The most common cause for transplantation was cryptogenic cirrhosis (44.4%). Tumor size was 2 cm or less in all patients, vascular invasion was detected in 11.1% of the patients, and tumor, node, metastasis (TNM) classification was stage I in 77.8%. Eight patients (88.9%) remained alive at the cessation of the analysis with a mean follow-up of 60 +/- 30.4 months. There was no tumor recurrence in any patient. Statistical analysis showed significant differences between undetected and detected HCCs when causes of pretransplantation liver disease, peak AFP level, tumor size, number of tumors, presence of vascular invasion or pathological differentiation were compared. Undetected HCCs were associated with a better survival rate after liver transplantation (p = 0.008).
Patients with undetected HCCs at OLT have a favorable outcome with tumor-free survival. Most patients had small, early-stage HCCs, but the possibility of finding tumors greater than 2 cm, multifocal lesions, and vascular invasion exist despite thorough investigation. An exhaustive histopathological search of the explant for malignancy will allow for greater accuracy in prognosis.
背景/目的：本研究旨在明确肝移植时发现的未被检测出的肝细胞癌（HCC）患者的临床特征及预后情况。肝移植患者尽管术前检查显示甲胎蛋白水平正常和/或无可见放射学病变，但意外发现患有HCC，被定义为有未被检测出的HCC。
其中32例患者在移植肝中经组织学诊断为HCC。未被检测出的HCC定义为仅在移植肝病理评估中发现的癌，术前检查显示血清甲胎蛋白（AFP）水平正常（<20 ng/mL）和/或术前放射学评估无可疑病变。
9例患者的肿瘤符合未被检测出的HCC标准。最常见的移植原因是隐源性肝硬化（44.4%）。所有患者肿瘤大小均为2 cm或更小，11.1%的患者检测到血管侵犯，77.8%的患者肿瘤、淋巴结、转移（TNM）分类为I期。分析结束时，8例患者（88.9%）存活，平均随访时间为60±30.4个月。所有患者均无肿瘤复发。统计分析显示，比较移植前肝病病因、AFP峰值水平、肿瘤大小、肿瘤数量、血管侵犯情况或病理分化程度时，未被检测出的HCC与已被检测出的HCC之间存在显著差异。肝移植后，未被检测出的HCC患者生存率更高（p = 0.008）。
OLT时未被检测出的HCC患者预后良好，无瘤生存。大多数患者患有小的早期HCC，但尽管进行了全面检查，仍有可能发现大于2 cm的肿瘤、多灶性病变和血管侵犯。对移植肝进行详尽的恶性肿瘤组织病理学检查将提高预后准确性。
