Baccarani U, Benzoni E, Adani G L, Avellini C, Lorenzin D, Sainz-Barriga M, Bresadola V, Uzzau A, Risaliti A, Beltrami C A, Bresadola F
Department of Surgery and Transplantation, University Hospital of Udine, Udine, Italy.
Transplant Proc. 2007 Jul-Aug;39(6):1898-900. doi: 10.1016/j.transproceed.2007.05.045.
The best therapy for hepatocellular carcinoma (HCC) is still debated. Hepatic resection (HR) is the treatment of choice for single HCC in Child A patients, whereas liver transplantation (OLT) is usually reserved for Child B and C patients with multiple nodules. The aim of this study was to compare HR and OLT for HCC within the Milan criteria on an intention-to-treat basis. Forty-eight patients were treated by OLT and 38 by HR. Three- and 5-year patient survival rates were significantly higher (P = .0057) in the OLT group (79% and 74%) than after HR (61% and 26%). The 3- and 5-year disease-free survival rate was better (P = .0005) for OLT (74% and 74%) versus HR (41% and 11%). The probability of HCC recurrences after resection was greater (P = .0002) than after transplantation, achieving 31% and 76% for HR and 2% and 2% for OLT at 3 and 5 years after surgery. The median waiting list time was 118 days; two patients dropped out for HCC progression. We concluded that OLT is superior to HR for small HCC in cirrhotic patients assuming that OLT can be performed within 6 to 10 months after listing to reduce dropouts due to tumor progression.
肝细胞癌（HCC）的最佳治疗方法仍存在争议。肝切除术（HR）是Child A级患者单发HCC的首选治疗方法，而肝移植（OLT）通常用于患有多个结节的Child B级和C级患者。本研究的目的是在意向性治疗的基础上比较符合米兰标准的HCC患者接受HR和OLT的疗效。48例患者接受了OLT治疗，38例接受了HR治疗。OLT组患者的3年和5年生存率（分别为79%和74%）显著高于HR组（分别为61%和26%）（P = 0.0057）。OLT组的3年和5年无病生存率（分别为74%和74%）优于HR组（分别为41%和11%）（P = 0.0005）。切除术后HCC复发的概率高于移植术后（P = 0.0002），术后3年和5年HR组的复发率分别为31%和76%，OLT组分别为2%和2%。等待名单的中位时间为118天；两名患者因HCC进展退出。我们得出结论，对于肝硬化患者的小HCC，OLT优于HR，前提是OLT可以在列入名单后的6至10个月内进行，以减少因肿瘤进展而退出的情况。
