Baccarani Umberto, Isola Miriam, Adani Gian L, Benzoni Enrico, Avellini Claudio, Lorenzin Dario, Bresadola Fabrizio, Uzzau Alessandro, Risaliti Andrea, Beltrami Antonio P, Soldano Franca, De Anna Dino, Bresadola Vittorio
Department of Surgery and Transplantation, University Hospital of Udine, Udine, Italy.
Transpl Int. 2008 Mar;21(3):247-54. doi: 10.1111/j.1432-2277.2007.00597.x. Epub 2007 Nov 20.
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 (LT) is usually reserved for Child B and C patients with single or multiple nodules. The aim of this study was to compare HR and LT for HCC within the Milan criteria on an intention-to-treat basis. Forty-eight patients were treated by LT and 38 by HR. The median time on the waiting list for transplantation was 118 days. The estimated overall survival was significantly higher (P = 0.005) in the LT group than in the HR one. The estimated freedom from recurrence was also significantly higher (P < 0.0001) for LT patients than for HR ones. Indeed, the probability of HCC recurrence after resection was higher than after transplantation achieving 31% and 76% for HR and 2% and 2% for LT at 3 and 5 years after surgery. Multivariate analysis confirmed that transplantation was superior to resection in terms of patient's survival and risk of HCC recurrence. We conclude that LT is superior to HR for small HCC in cirrhotic patients assuming that LT should be performed within 6-10 months after listing to reduce the dropouts for reasons of 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级患者单个HCC的首选治疗方法，而肝移植（LT）通常适用于患有单个或多个结节的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LT的疗效。48例患者接受了LT治疗，38例接受了HR治疗。移植等待名单上的中位时间为118天。LT组的估计总生存率显著高于HR组（P = 0.005）。LT患者的估计无复发生存率也显著高于HR患者（P < 0.0001）。事实上，切除术后HCC复发的概率高于移植后，术后3年和5年时，HR组的复发概率分别为31%和76%，LT组为2%和2%。多因素分析证实，在患者生存和HCC复发风险方面，移植优于切除。我们得出结论，对于肝硬化患者的小HCC，LT优于HR，前提是LT应在列入名单后的6至10个月内进行，以减少因肿瘤进展而导致的退出率。
