针对超出米兰标准的肝癌患者的活体供肝肝移植：扩大标准的提议。

Living donor liver transplantation for patients with HCC exceeding the Milan criteria: a proposal of expanded criteria.

作者信息

Takada Yasutsugu, Ito Takashi, Ueda Mikiko, Sakamoto Seisuke, Haga Hironori, Maetani Yoji, Ogawa Kohei, Ogura Yasuhiro, Oike Fumitaka, Egawa Hiroto, Uemoto Shinji

机构信息

Department of Surgery, Kyoto University, Kyoto, Japan.

出版信息

Dig Dis. 2007;25(4):299-302. doi: 10.1159/000106908.

DOI:10.1159/000106908

PMID:17960063

Abstract

BACKGROUND

Optimal indications for living donor liver transplantation (LDLT) for patients with hepatocellular carcinoma (HCC) have yet not been established. The aim of the present study was to determine optimal criteria including categories outside the Milan criteria (MC) and still with a predictably good outcome.

PATIENTS AND METHODS

Between February 1999 and December 2007, 136 patients with HCC underwent LDLT. Based on preoperative imaging studies, 74 patients met the MC and 62 did not.

RESULTS

Overall patient survival rate at 5 years was 70%. Patients who exceeded MC but presented with <or=10 tumors and all <or=5 cm in diameter (n = 33) displayed similar 5-year recurrence rate to those within MC (7 vs. 10%). Based on the results of multivariate analysis of risk factors for recurrence, we defined new criteria as n <or=10 and all <or=5 cm and PIVKA-II <or=400 mAU/ml. The 5-year recurrence rate for the 83 patients who met the new criteria was significantly lower than for the 44 patients who exceeded them (5 vs. 61%, p < 0.0001). Similarly, patients who met the new criteria showed a significantly better 5-year survival rate (87 vs. 37%, p < 0.0001).

CONCLUSION

The selection criteria may be safely extended up to n <or=10 and all <or=5 cm in diameter and PIVKA-II <or=400 mAU/ml with acceptable outcomes.

摘要

背景

肝细胞癌（HCC）患者活体肝移植（LDLT）的最佳适应证尚未确定。本研究的目的是确定最佳标准，包括米兰标准（MC）以外但仍有可预测的良好预后的类别。

患者与方法

1999年2月至2007年12月期间，136例HCC患者接受了LDLT。根据术前影像学检查，74例患者符合MC，62例不符合。

结果

5年总体患者生存率为70%。超过MC但肿瘤数量≤10个且所有肿瘤直径≤5 cm的患者（n = 33），其5年复发率与符合MC的患者相似（7%对10%）。基于复发危险因素的多因素分析结果，我们将新标准定义为n≤10、所有肿瘤直径≤5 cm且异常凝血酶原（PIVKA-II）≤400 mAU/ml。符合新标准的83例患者的5年复发率显著低于超过新标准的44例患者（5%对61%，p < 0.0001）。同样，符合新标准的患者5年生存率显著更高（87%对37%，p < 0.0001）。