Unità di Chirurgia Oncologica, Istituto Oncologico Veneto, IRCCS, Padova, Italy.
Ann Surg Oncol. 2010 Sep;17(9):2290-302. doi: 10.1245/s10434-010-0993-4. Epub 2010 Mar 9.
How to prioritize patients with hepatocellular carcinoma (HCC) for liver transplantation (LT) remains controversial. This study was designed to assess the effectiveness of a policy for prioritizing HCC patients according to their response to pre-LT therapy.
The study period was from 2000 to 2008. Dropout criteria included macroscopic vascular invasion, metastases, and poorly differentiated grade at pre-LT biopsy. A specific treatment algorithm was adopted to treat HCC before LT, and the effect of treatment was evaluated 3 months after listing or after the diagnosis of HCC for patients diagnosed while already on the waiting list. Patients were divided into two groups: group 1, patients with disease that completely or partially responded to therapy; and group 2, patients with stable, progressive, or untreatable disease. Group 2 patients were prioritized for LT unless full restaging and repeat biopsy identified dropout criteria.
At the 3-month visit, 62 HCC patients (42%) were assigned to group 2 and 85 (58%) to group 1. Eleven of 12 dropouts due to tumor progression came from group 2 (P < 0.01). Response to therapy was the sole predictor of dropout probability, independent of tumor stage (competing risk analysis). The 42 patients in group 2 who were transplanted had much the same 3-year post-LT survival rate as the 57 transplanted patients in group 1 (with survival rates of 82% and 83%, respectively; P > 0.05), but a slightly higher risk of post-LT HCC recurrence (13% and 2%, respectively; P = 0.04).
Response to therapy is a potentially effective tool for prioritizing HCC patients for LT.
如何为肝细胞癌（HCC）患者优先进行肝移植（LT）仍然存在争议。本研究旨在评估根据患者LT 前治疗反应为 HCC 患者分级的政策的有效性。
研究期间为 2000 年至 2008 年。失访标准包括巨观血管侵犯、转移和 LT 前活检中低分化分级。在 LT 前采用特定的治疗算法治疗 HCC，并在列入名单后 3 个月或在等待名单上诊断 HCC 后评估治疗效果。患者分为两组：组 1，治疗完全或部分缓解的患者；组 2，病情稳定、进展或无法治疗的患者。除非完全重新分期和重复活检发现失访标准，否则组 2 患者将优先进行 LT。
在 3 个月时，62 例 HCC 患者（42%）被分配到组 2，85 例（58%）被分配到组 1。12 例因肿瘤进展而失访的患者均来自组 2（P < 0.01）。治疗反应是唯一预测失访概率的因素，与肿瘤分期无关（竞争风险分析）。在组 2 中转的 42 例患者的 3 年 LT 后生存率与组 1 中转的 57 例患者相似（生存率分别为 82%和 83%；P > 0.05），但 LT 后 HCC 复发的风险略高（分别为 13%和 2%；P = 0.04）。
治疗反应是为 HCC 患者优先进行 LT 的一种潜在有效工具。
