肝移植是米兰标准以外治疗肝细胞癌的一种替代方法。

Liver transplantation is an alternative treatment of hepatocellular carcinoma beyond the Milan criteria.

机构信息

Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

出版信息

Am J Surg. 2010 Aug;200(2):252-7. doi: 10.1016/j.amjsurg.2009.07.049. Epub 2010 Feb 1.

DOI:10.1016/j.amjsurg.2009.07.049

PMID:20122677

Abstract

BACKGROUND

The decision to perform liver transplantation (LT) or liver resection (LR) for patients with hepatocellular carcinoma (HCC) who are beyond the Milan criteria remains controversial.

METHODS

We retrospectively analyzed outcome data for 179 patients with HCC beyond the Milan criteria who were treated with LR (n = 135) or LT (n = 44). Univariate and multivariate Cox proportional hazard models were established. Kaplan-Meier survival curves were generated, and a log-rank test was performed to compare group survival status.

RESULTS

Patients who underwent LR group were significantly older, had a lower TNM stage, and were more likely to have unilateral disease and noncirrhotic liver. Significantly more patients in the LR group had recurrence (53.3% vs 29.5%) or died (61.5% vs 43.2%) than patients in the LT group. Recurrence-free survival rates were 11.9% for the LR group and 61.5% for the LT group. The median overall survival duration showed no statistically difference between the LR group (28.0 months) and the LT group (50.0 months).

CONCLUSIONS

LT may be the better choice for patients with HCC beyond the Milan criteria.

摘要

背景

对于超出米兰标准的肝细胞癌（HCC）患者，是选择肝移植（LT）还是肝切除术（LR）仍然存在争议。

方法

我们回顾性分析了 179 例超出米兰标准的 HCC 患者的治疗结果数据，这些患者接受了 LR（n=135）或 LT（n=44）治疗。建立了单因素和多因素 Cox 比例风险模型。生成 Kaplan-Meier 生存曲线，并进行对数秩检验比较组的生存状况。

结果

LR 组患者年龄明显更大，TNM 分期更低，单侧病变和非肝硬化的可能性更大。LR 组的复发（53.3% vs. 29.5%）或死亡（61.5% vs. 43.2%）的患者明显多于 LT 组。LR 组的无复发生存率为 11.9%，LT 组为 61.5%。LR 组（28.0 个月）和 LT 组（50.0 个月）的中位总生存时间无统计学差异。