Varona M A, Del Pino J M, Barrera M, Arranz J, Hernández B M, Perez H F, Padilla J, Fuentes J S, Aguirre A, Mendez S, Sanz P, Gianchandani R, Perera A, Soriano A
Department of Surgery, Universitary Hospital of Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.
Transplant Proc. 2009 Apr;41(3):1005-8. doi: 10.1016/j.transproceed.2009.02.029.
Orthotopic liver transplantation (OLT) for patients with cirrhosis and concomitant hepatocellular carcinoma (HCC) in early stages is the treatment of choice, with an acceptable recurrence rate and excellent survival.
We sought to evaluate (1) the accuracy of preoperative imaging; (2) the impact of pre-OLT treatments on survival and recurrence; and (3) the influence of beyond Milan criteria selection on global outcomes.
We studied a cohort of 65 patients with HCC among 300 consecutive OLTs over a single 12-year experience. We analyzed the overall outcomes of survival and recurrence, the accuracy of preoperative diagnosis and staging the influence of neoadjuvant treatment prior to OLT, and the effect on overall outcomes beyond the Milan criteria in our series.
The 65 transplants were performed for HCC, mostly in association with hepatitis C virus and alcoholic cirrhosis with HTP. At a mean follow-up of 40.32 months, the recurrence rate was 5.7% among the 61 HCC confirmed by histopathology. The overall survival was 30.07. Actuarial survivals at 1, 5, and 10 years were 82%, 77%, and 62%, respectively. Six retransplants occurred among the seven graft losses albeit with poor survival after the second graft. Most explants showed low pTNM stages with favorable microscopic features. Preoperative imaging tests failed to achieve an accurate diagnosis in 15.38% of the series. The role of alpha-fetoprotein (AFP) and hepatic biopsy was irrelevant. Unfavorable histopathologic factors predicted a greater recurrence rate, but had no influence on survival. Neither recurrence nor survival were modified by pre-OLT therapy.
In our series, AFP, hepatic biopsy, and pre-OLT treatment had limited roles. Radiological imaging techniques underestimated HCC staging and lead to a misdiagnosis to an expected degree. Despite these findings, this single institution experience with OLT for HCC showed excellent survivals with a low recurrence rate including cases of patients beyond the Milan criteria.
对于患有肝硬化并伴有早期肝细胞癌（HCC）的患者，原位肝移植（OLT）是首选治疗方法，其复发率可接受且生存率良好。
我们试图评估（1）术前成像的准确性；（2）OLT前治疗对生存和复发的影响；（3）超出米兰标准选择对总体结果的影响。
我们研究了在单一的12年经验中300例连续OLT患者中的65例HCC患者队列。我们分析了生存和复发的总体结果、术前诊断和分期的准确性、OLT前新辅助治疗的影响以及超出米兰标准对我们系列中总体结果的影响。
65例移植手术是针对HCC进行的，大多数与丙型肝炎病毒和酒精性肝硬化合并HTP有关。平均随访40.32个月，61例经组织病理学确诊的HCC患者复发率为5.7%。总体生存率为30.07。1年、5年和10年的精算生存率分别为82%、77%和62%。7例移植肝失功中有6例进行了再次移植，尽管第二次移植后生存率较差。大多数切除标本显示低pTNM分期且具有良好的微观特征。术前成像检查在该系列的15.38%中未能实现准确诊断。甲胎蛋白（AFP）和肝活检的作用不相关。不良组织病理学因素预示着更高的复发率，但对生存率没有影响。OLT前治疗对复发和生存均无改善。
在我们的系列中，AFP、肝活检和OLT前治疗的作用有限。放射成像技术低估了HCC分期并导致了预期程度的误诊。尽管有这些发现，但该单中心HCC的OLT经验显示出优异的生存率和低复发率，包括超出米兰标准的患者病例。
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