Herrero J Ignacio, Sangro Bruno, Pardo Fernando, Quiroga Jorge, Iñarrairaegui Mercedes, Rotellar Fernando, Montiel Custodia, Alegre Felix, Prieto Jesus
Liver Unit, Clinica Universitaria de Navarra, Pamplona (Navarra), Spain.
Liver Transpl. 2008 Mar;14(3):272-8. doi: 10.1002/lt.21368.
Milan criteria are the most frequently used limits for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC), but our previous experience with expanded criteria showed encouraging results. The aim of this study was to investigate whether our expanded Clinica Universitaria de Navarra (CUN) criteria (1 nodule up to 6 cm or 2-3 nodules up to 5 cm each) could be used to select patients with HCC for LT. Eighty-five patients with HCC fulfilling CUN criteria were included as candidates for LT. Survival of transplanted HCC patients was compared with survival of patients without HCC (n = 180). After the exclusion of 2 patients with tumor seeding of the chest wall due to pre-LT tumor biopsy, survival and recurrence rates were compared according to tumor staging. Twenty-six out of 85 (30%) patients exceeded Milan criteria. Twelve patients had tumor progression on the waiting list. Patients exceeding Milan criteria had a higher dropout rate due to tumoral progression. One-, 3-, 5-, 7-, and 10-year survival rates of the 73 transplanted HCC patients were 86%, 74%, 70%, 61%, and 50%, respectively. Survival of patients with HCC was significantly lower than that of patients without HCC, but by multivariate analysis, HCC was not associated with lower survival. Tumor recurrence and survival rates were similar for patients fulfilling Milan and CUN criteria. Pathological staging showed 55 patients within Milan criteria, 7 patients exceeding them but within CUN criteria, and 9 patients exceeding CUN criteria. Tumor recurrence rates were 2/55 (4%), 0/7 (0%), and 4/9 (44%) in each of these groups, respectively. In conclusion, following CUN criteria could increase the number of HCC patients who could benefit from LT, without worsening the results. Because of the short number of patients in this series, these data need external validation.
米兰标准是肝细胞癌（HCC）患者肝移植（LT）中最常用的限制标准，但我们之前采用扩大标准的经验显示了令人鼓舞的结果。本研究的目的是调查我们扩大后的纳瓦拉大学临床医院（CUN）标准（单个结节最大直径达6 cm或2 - 3个结节，每个最大直径达5 cm）是否可用于选择接受LT的HCC患者。85例符合CUN标准的HCC患者被纳入LT候选者。将移植的HCC患者的生存率与无HCC患者（n = 180）的生存率进行比较。在排除2例因LT前肿瘤活检导致胸壁肿瘤播散的患者后，根据肿瘤分期比较生存率和复发率。85例患者中有26例（30%）超出米兰标准。12例患者在等待名单上出现肿瘤进展。超出米兰标准的患者因肿瘤进展导致的退出率更高。73例移植的HCC患者的1年、3年、5年、7年和10年生存率分别为86%、74%、70%、61%和50%。HCC患者的生存率显著低于无HCC患者，但经多因素分析，HCC与较低生存率无关。符合米兰标准和CUN标准的患者的肿瘤复发率和生存率相似。病理分期显示，55例患者符合米兰标准，7例超出米兰标准但符合CUN标准，9例超出CUN标准。这些组中肿瘤复发率分别为2/55（4%）、0/7（0%）和4/9（44%）。总之，遵循CUN标准可增加能从LT中获益的HCC患者数量，且不使结果变差。由于本系列患者数量较少，这些数据需要外部验证。
