肝移植与肝切除术治疗肝细胞癌。
Liver transplantation versus liver resection for the treatment of hepatocellular carcinoma.
机构信息
Department of Surgery, Catholic University of Korea, 505 Banpodong, Seocho-Gu, Seoul 137-701, Korea.
出版信息
J Surg Oncol. 2010 Jan 1;101(1):47-53. doi: 10.1002/jso.21415.
PURPOSE
Liver resection (LR) and liver transplantation (LT) are considered the only two potentially curative treatments for hepatocellular carcinoma (HCC). Recently, there has been an intense debate as to whether LR or LT is the optimal initial treatment for patients with Child A or B cirrhosis. The aim of this study was to compare the results of LR and LT in patients with HCC and with Child A or B cirrhosis in a single center over a 10-year period.
METHOD
Seventy-eight patients were treated with LT and 130 were treated with LR. We evaluated patient characteristics, short-term results such as hospital stay, postoperative complication, mortality, and long-term results such as overall and recurrence-free survival and recurrence.
RESULTS
The hospital stay of the LT group was significantly longer than that of the LR group (P < 0.001). The postoperative complication rate and the early operative mortality rate were similar between the two groups. The overall survival rate was higher after LT than it was after LR, but not to a statistically significant degree (P = 0.267). The recurrence-free survival rate was significantly higher after LT than it was after LR (P = 0.002). Within and beyond the Milan criteria, the overall survival rate was higher after LT than it was after LR, but not to a statistically significant degree. The recurrence-free survival rate was significantly higher after LT than it was after LR in the patients within Milan criteria (P < 0.001). HCC recurred more frequently after resection (51.5%) than it did after transplantation (29.5%) (P < 0.001), and HCC recurrence developed in the liver more frequently after LR than it did after LT (P = 0.002). However, after recurrence, LR had better survival than LT did, but not to a statistically significant degree (P = 0.177).
CONCLUSION
LT should be considered as the primary treatment in patients with HCC within the Milan criteria. LR is recommended for patients with HCC beyond the Milan criteria. The LT group showed a significantly lower recurrence rate than the LR group. However, in the case of recurrence, the LT group showed a poorer long-term outcome than the LR group.
目的
肝切除术（LR）和肝移植（LT）被认为是治疗肝细胞癌（HCC）的唯一两种潜在根治性治疗方法。最近，对于 Child A 或 B 级肝硬化患者，LR 或 LT 哪种是最佳初始治疗方法存在激烈的争论。本研究的目的是在 10 年期间在单中心比较 LR 和 LT 治疗 HCC 合并 Child A 或 B 级肝硬化患者的结果。
方法
78 例患者接受 LT 治疗，130 例患者接受 LR 治疗。我们评估了患者特征、短期结果（如住院时间、术后并发症、死亡率）和长期结果（如总生存和无复发生存率以及复发）。
结果
LT 组的住院时间明显长于 LR 组（P < 0.001）。两组术后并发症发生率和早期手术死亡率相似。LT 后总生存率高于 LR，但无统计学意义（P = 0.267）。LR 后无复发生存率明显高于 LR（P = 0.002）。在米兰标准内和超出米兰标准，LT 后总生存率高于 LR，但无统计学意义。在米兰标准内的患者中，LR 后无复发生存率明显高于 LR（P < 0.001）。LR 后 HCC 复发率（51.5%）高于 LT（29.5%）（P < 0.001），LR 后 HCC 复发更常见于肝脏（P = 0.002）。然而，复发后，LR 的生存率优于 LT，但无统计学意义（P = 0.177）。
结论
LT 应作为米兰标准内 HCC 患者的主要治疗方法。对于超出米兰标准的 HCC 患者，建议行 LR。LT 组的复发率明显低于 LR 组。然而，在复发的情况下，LT 组的长期预后比 LR 组差。
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