Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-040, Korea.
Aliment Pharmacol Ther. 2010 Feb 1;31(3):415-23. doi: 10.1111/j.1365-2036.2009.04167.x. Epub 2009 Oct 12.
Long-term results after downstaging hepatocellular carcinoma (HCC) prior to liver transplantation (LT) remain unknown.
To investigate dropouts and post-transplant outcome among patients with downstaged HCC by transarterial chemo-lipiodolization (TACL).
Between 2000 and 2007, 386 patients with HCC initially exceeding Milan criteria underwent TACL for tumour downstaging and were consecutively enrolled.
Overall, 160 (41.5%) patients achieved successful downstaging of HCC to within Milan criteria. During the follow-up, 82 eventually dropped off the waiting list for LT, with estimated dropout rates at 1, 2 and 5 years of 46.7%, 70.2%, and 87.2%, respectively. The overall post-transplant survival rates at 1, 2 and 5 years were 89.2%, 70.3% and 54.6% and the corresponding rates for recurrence-free survival were 74.7%, 71.8% and 66.3% respectively. Multivariate analysis indentified alpha-fetoprotein (AFP) levels > or = 100 ng/mL at LT (P = 0.003), maximum tumour size > or = 7 cm (P = 0.002) and the lack of complete necrosis by TACL (P = 0.048) as independent predictors of HCC recurrence after LT. Patients with none of these risk factors had an excellent post-transplant outcome, with an 87.5% probability of recurrence-free survival up to 6 years.
These long-term results may contribute to the database for optimizing management of LT candidates with downstaged HCC. Based on our data, patients with a maximum tumour size <7 cm who achieve complete necrosis together with AFP levels <100 ng/mL at LT may be the best candidates for LT following downstaging using TACL.
肝癌（HCC）患者在肝移植（LT）前降期后的长期结果尚不清楚。
研究经肝动脉化疗栓塞（TACL）降期后 HCC 患者的脱落率和移植后结局。
2000 年至 2007 年间，386 例最初超过米兰标准的 HCC 患者接受 TACL 以进行肿瘤降期，并连续纳入研究。
总体而言，160 例（41.5%）患者成功地将 HCC 降期至米兰标准内。在随访期间，82 例最终从 LT 等待名单中脱落，估计 1、2 和 5 年的脱落率分别为 46.7%、70.2%和 87.2%。1、2 和 5 年的总体移植后生存率分别为 89.2%、70.3%和 54.6%，相应的无复发生存率分别为 74.7%、71.8%和 66.3%。多因素分析确定 LT 时 AFP 水平>或=100ng/ml（P=0.003）、最大肿瘤直径>或=7cm（P=0.002）和 TACL 未能完全坏死（P=0.048）是 LT 后 HCC 复发的独立预测因素。没有这些危险因素的患者移植后预后良好，6 年内无复发生存率的可能性为 87.5%。
这些长期结果可能有助于优化 LT 候选者降期后 HCC 管理的数据库。根据我们的数据，最大肿瘤直径<7cm 的患者，如果在 LT 时 AFP 水平<100ng/ml 且达到完全坏死，则可能是 TACL 降期后接受 LT 的最佳候选者。
