肝细胞癌肝移植术后肿瘤复发：复发途径及预后因素
Tumor recurrence after liver transplantation for hepatocellular carcinoma: recurrence pathway and prognostic factors.
作者信息
Pérez-Saborido B, de los Galanes S Jiménez, Menéu-Díaz J C, Romero C Jiménez, Elola-Olaso A Moreno, Suárez Y Fundora, Valencia V Barra, Moreno-González E
机构信息
General, Digestive and Abdominal Organs Transplantation Surgical Department, 12 de Octubre Hospital, Madrid, Spain.
出版信息
Transplant Proc. 2007 Sep;39(7):2304-7. doi: 10.1016/j.transproceed.2007.06.059.
INTRODUCTION
Liver transplantation (OLT) has been advocated as a good management option for patients with carcinoma hepatocellular (HCC). More recurrences are extrahepatic due to many pathological factors.
PATIENTS AND METHODS
From April 1986 to December 2003, we performed 95. OLTs for HCC including 73% men of mean age of 54.7 years and 25.3% not filling Mazzaferro's criteria.
RESULTS
The recurrence incidence was 15.8% (n = 15), including only extrahepatic lesions in 11 (mainly lung recurrence, seven) and hepatic plus extrahepatic in four. Main late mortality was due to tumor recurrence (n = 12, 33.3%). No differences were observed among sex, preoperative chemoembolization, age, Child, Okuda, etiology, or satellite nodules. A greater incidence of tumor recurrence was observed with a preoperative biopsy (45.5% vs 5.9%, P = .0001); and alpha fetoprotein (AFP) > 200 ng/mL (37.5% vs 13.3%, P = .08); known HCC (25.5% vs 3.1%, P = .008); vascular invasion (42.1% vs 10.3%, P = .001); > 5 cm single nodule (50% vs 13%, P = .004); more than three nodules (50% vs 13.9%, P = .01); moderately to poorly differentiated tumors (37.5% vs 12.7%, P = .01); pTNM IV (50% vs 8.7%, P = .0001); and not meeting Milan criteria (40.9% vs 9.2%, P = .001). These are the same factors for extrahepatic recurrence. For hepatic recurrence the prognostic factors were: vascular invasion (15.8% vs 1.5%, P = .008), more than three nodules (25% vs 2.5%, P = .004), moderately to poorly differentiated tumors (18.8% vs 1.4%, P = .003), pTNM IV (16.7% vs 1.4%, P = .006), and not meeting Milan criteria (13.6% vs 1.5%, P = .01).
CONCLUSIONS
Recurrence incidence with Milan criteria was less than 10%, mainly extrahepatic (lung). Prognostic factors for tumor recurrence were pathological features, namely vascular invasion, more than three nodules, size larger than 5 cm, moderately to poorly differentiated tumors, pTNM IV stage. The use of preoperative chemoembolization did not decrease the recurrence rate. A preoperative biopsy increased the incidence of extrahepatic recurrence.
引言
肝移植（OLT）已被视为肝细胞癌（HCC）患者的一种良好治疗选择。由于多种病理因素，更多复发发生在肝外。
患者与方法
1986年4月至2003年12月，我们对HCC患者进行了95例肝移植手术，其中男性占73%，平均年龄54.7岁，25.3%的患者不符合马佐法罗标准。
结果
复发率为15.8%（n = 15），其中11例仅为肝外病变（主要是肺转移，7例），4例为肝内及肝外复发。主要的晚期死亡率归因于肿瘤复发（n = 12，33.3%）。在性别、术前化疗栓塞、年龄、Child分级、奥田分期、病因或卫星结节方面未观察到差异。术前活检的肿瘤复发率更高（45.5%对5.9%，P = .0001）；甲胎蛋白（AFP）> 200 ng/mL（37.5%对13.3%，P = .08）；已知HCC（25.5%对3.1%，P = .008）；血管侵犯（42.1%对10.3%，P = .001）；单个结节> 5 cm（50%对13%，P = .004）；超过三个结节（50%对13.9%，P = .01）；中度至低分化肿瘤（37.5%对12.7%，P = .01）；pTNM IV期（50%对8.7%，P = .0001）；以及不符合米兰标准（40.9%对9.2%，P = .001）。这些也是肝外复发的相同因素。对于肝内复发，预后因素为：血管侵犯（15.8%对1.5%，P = .008），超过三个结节（25%对2.5%，P = .004），中度至低分化肿瘤（18.8%对1.4%，P = .003），pTNM IV期（16.7%对1.4%，P = .006），以及不符合米兰标准（13.6%对1.5%，P = .01）。
结论
符合米兰标准的复发率低于10%，主要为肝外复发（肺）。肿瘤复发的预后因素为病理特征，即血管侵犯、超过三个结节、直径大于5 cm、中度至低分化肿瘤、pTNM IV期。术前化疗栓塞的使用并未降低复发率。术前活检增加了肝外复发的发生率。
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