肝癌大体分类在活体肝移植中的预后意义。

Prognostic importance of the gross classification of hepatocellular carcinoma in living donor-related liver transplantation.

机构信息

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

出版信息

Br J Surg. 2011 Feb;98(2):261-7. doi: 10.1002/bjs.7311.

DOI:10.1002/bjs.7311

PMID:21072849

Abstract

BACKGROUND

The gross classification of hepatocellular carcinoma (HCC) has been reported to be a significant prognostic factor for patients with HCC undergoing partial hepatectomy. The present study investigated whether the gross classification of HCC is also a prognostic factor in living donor-related liver transplantation (LDLT).

METHODS

Some 119 patients undergoing LDLT for HCC were identified retrospectively from a prospective institutional database containing information on all LDLTs carried out between 1996 and 2009. Patients were divided into three groups according to the gross classification of the largest tumour in the explanted liver: type 1 HCC, single nodular type (81 patients); type 2, single nodular type with extranodular growth (21); and type 3, contiguous multinodular type (17). Clinicopathological factors and recurrence-free survival rates were compared.

RESULTS

Recurrence-free survival rates for the whole group were 87·7 per cent at 1 year, 83·5 per cent at 3 years and 81·0 per cent at 5 years after LDLT. Type 3 HCC was associated with large tumour size, poor histological grade, a high incidence of microvascular invasion and multiple tumours. Independent predictors of poor recurrence-free survival were preoperative serum level of des-γ-carboxy prothrombin exceeding 300 mAU/ml, microvascular invasion and type 3 HCC.

CONCLUSION

The gross classification of HCC was an independent predictor for recurrence of HCC in patients undergoing LDLT.

摘要

背景

肝细胞癌（HCC）的大体分类已被报道为接受部分肝切除术的 HCC 患者的重要预后因素。本研究调查了 HCC 的大体分类在活体肝移植（LDLT）中是否也是一个预后因素。

方法

回顾性分析了 1996 年至 2009 年期间在一家机构的前瞻性数据库中接受 LDLT 治疗的 119 例 HCC 患者的资料。根据切除肝脏中最大肿瘤的大体分类，将患者分为三组：1 型 HCC，单发结节型（81 例）；2 型，单发结节型伴外生生长（21 例）；3 型，连续多结节型（17 例）。比较了临床病理因素和无复发生存率。

结果

全组患者 LDLT 后 1 年、3 年和 5 年的无复发生存率分别为 87.7%、83.5%和 81.0%。3 型 HCC 与肿瘤体积大、组织学分级差、微血管侵犯发生率高、肿瘤多发有关。无复发生存不良的独立预测因素是术前血清去γ-羧基凝血酶原水平超过 300 mAU/ml、微血管侵犯和 3 型 HCC。