Zheng Shu-Sen, Xu Xiao, Wu Jian, Chen Jun, Wang Wei-Lin, Zhang Min, Liang Ting-Bo, Wu Li-Ming
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Transplantation. 2008 Jun 27;85(12):1726-32. doi: 10.1097/TP.0b013e31816b67e4.
Liver transplantation (LT) has been the treatment of choice for patients with hepatocellular carcinoma (HCC). This study was designed to summarize our experience in LT for HCC patients and establish a new set of criteria for patient selection and prognosis prediction.
Data of 195 patients with HCC were retrospectively analyzed and various clinical and pathological factors for survival and tumor-free survival were examined by univariate and multivariate analyses.
Macrovascular invasion, preoperative serum alpha fetoprotein (AFP) level, tumor size, multifocality, histopathologic grading, distribution, and cirrhosis background were significant factors for survival and tumor-free survival by univariate analysis. Multivariate analysis identified macrovascular invasion, tumor size, preoperative AFP level, and histopathologic grading were prognostic factors independently associated with patient survival or tumor-free survival (RR=1.688-2.779, P=0.000-0.034). Based on the prognostic stratification of different risk groups of patients without macrovascular invasion, Hangzhou criteria was established, containing one of the two following items: (a) Total tumor diameter less than or equal to 8 cm; (b) total tumor diameter more than 8 cm, with histopathologic grade I or II and preoperative AFP level less than or equal to 400 ng/mL, simultaneously. The difference between survival curves of patients fulfilling Milan criteria (n=72) and patients fulfilling Hangzhou criteria (n=99) did not achieve statistical significance (5-year survival rates: 78.3% vs. 72.3%, P>0.05). Of the patients exceeding Milan criteria (n=123), those who fulfilled Hangzhou criteria (n=26) also had better prognosis than the others (n=97) (P=0.000).
The results of this study show a reliable and feasible candidates selection and prognostic criteria of LT in HCC patients.
肝移植（LT）一直是肝细胞癌（HCC）患者的首选治疗方法。本研究旨在总结我们对HCC患者进行肝移植的经验，并建立一套新的患者选择和预后预测标准。
回顾性分析195例HCC患者的数据，并通过单因素和多因素分析检查影响生存和无瘤生存的各种临床和病理因素。
单因素分析显示，大血管侵犯、术前血清甲胎蛋白（AFP）水平、肿瘤大小、多灶性、组织病理学分级、分布及肝硬化背景是影响生存和无瘤生存的重要因素。多因素分析确定大血管侵犯、肿瘤大小、术前AFP水平及组织病理学分级是与患者生存或无瘤生存独立相关的预后因素（RR=1.688 - 2.779，P=0.000 - 0.034）。基于无大血管侵犯患者不同风险组的预后分层，建立了杭州标准，包括以下两项之一：（a）肿瘤总直径小于或等于8 cm；（b）肿瘤总直径大于8 cm，同时组织病理学为I级或II级且术前AFP水平小于或等于400 ng/mL。符合米兰标准的患者（n=72）与符合杭州标准的患者（n=99）生存曲线差异无统计学意义（5年生存率：78.3%对72.3%，P>0.05）。在超过米兰标准的患者（n=123）中，符合杭州标准的患者（n=26）预后也优于其他患者（n=97）（P=0.000）。
本研究结果显示了一种可靠且可行的HCC患者肝移植候选者选择和预后标准。
