Pandey Durgatosh, Wai Chun Tao, Lee Kang Hoe, Tan Kai Chah
Department of Hepatobiliary Surgery and Liver Transplantation, Asian Centre of Liver Diseases & Transplantation, Gleneagles Hospital, Singapore.
Indian J Gastroenterol. 2008 Jul-Aug;27(4):148-52.
The indications of liver transplantation in hepatocellular carcinoma (HCC) are evolving. With the advent of living donor liver transplantation (LDLT), there is a renewed interest in this procedure for tumors beyond the standard Milan criteria.
We retrospectively analyzed the outcome of 28 patients who underwent LDLT for HCC in one institution. Survival analysis was done using the Kaplan-Meier method.
Of the 28 patients, 9, 12 and 7 had Child's A, B and C cirrhosis respectively; 26 (93%) had underlying hepatitis B or C. Nineteen patients (68%) had tumors exceeding the Milan criteria. Postoperative (within 90 days) mortality and morbidity rates were 2/28 (7%) and 7/28 (25%) respectively. The actuarial overall 1-year, 2-year and 3-year survival rates were 76%, 76% and 51%, respectively. The actuarial 1-year, 2-year and 3-year recurrence free survival rates (computed by censoring the data of patients who died of causes other than HCC recurrence) were 88%, 82% and 70%, respectively. Although the survival rates were better for tumors within the Milan criteria than those exceeding them, the difference was not significant.
LDLT is an effective modality in the treatment of HCC in patients with liver cirrhosis. It may also provide an opportunity for potential cure to patients with tumors beyond Milan criteria.
肝细胞癌（HCC）肝移植的适应证正在不断演变。随着活体肝移植（LDLT）的出现，对于超出标准米兰标准的肿瘤，人们对该手术重新产生了兴趣。
我们回顾性分析了在一家机构接受LDLT治疗HCC的28例患者的预后。采用Kaplan-Meier法进行生存分析。
28例患者中，分别有9例、12例和7例患有Child's A、B和C级肝硬化；26例（93%）患有潜在的乙型或丙型肝炎。19例（68%）患者的肿瘤超出米兰标准。术后（90天内）死亡率和发病率分别为2/28（7%）和7/28（25%）。精算的1年、2年和3年总生存率分别为76%、76%和51%。精算的1年、2年和3年无复发生存率（通过剔除死于非HCC复发原因患者的数据计算）分别为88%、82%和70%。虽然米兰标准内肿瘤的生存率高于超出该标准的肿瘤，但差异不显著。
LDLT是治疗肝硬化患者HCC的有效方式。它也可能为超出米兰标准的肿瘤患者提供潜在治愈的机会。
