Department of Hepatobiliary Surgery, General Hospital of PLA, Beijing 100853, China.
Hepatobiliary Pancreat Dis Int. 2011 Apr;10(2):143-50. doi: 10.1016/s1499-3872(11)60023-4.
The number of loco-regional therapies (LRTs) for hepatocellular carcinoma (HCC) has increased dramatically during the past decade. Many patients with HCC who were beyond the Milan criteria were allowed to receive a liver transplantation (LT) once the HCC was successfully down-staged. This retrospective study aimed to analyze the outcomes of LRTs prior to LT in patients with HCC beyond the Milan criteria.
We analyzed 56 patients treated from June 2006 to March 2010: 22 met the Milan criteria (T1+T2, 39.3%), 16 had T3 tumors (28.6%), and 11 had T4a tumors (19.6%), while 7 were suspected of tumor vascular invasion (T4b, 12.5%). All patients underwent preoperative LRTs, including transcatheter arterial chemoembolization, radiofrequency ablation, percutaneous ethanol injection, liver resection, and/or microwave coagulation therapy. The number of the patients who were successfully down-staged before LT, the types of LRTs used before LT, and their outcomes after LT were recorded.
Eleven patients had necrotic tumors (pT0, 19.6%); 6 had pT1 tumors (10.7%), 22 had pT2 tumors (39.3%), 6 had pT3 tumors (10.7%), 5 had pT4a tumors (8.9%), and 6 had pT4b tumors (10.7%). The histopathologic tumors of 39 patients (69.6%) were down-staged and met the established Milan criteria (pT0-2). Imaging-proven under-staging was present in 5 HCC patients (8.9%) who had tumors involving the intrahepatic venous system. Twenty-three patients (41.1%) had stable HCC and 10 (17.9%) died. The 1-, 3- and 4-year survival rates were 96%, 73% and 61%, respectively, with a mean survival time of 22.29+/-1.63 months. Six patients died of tumor recurrence. The 1-, 3- and 4-year recurrence-free survival (RFS) rates were 88%, 75% and 66%, respectively. The 3-year RFS of patients with pT0-2 tumors was 82%, which was markedly greater than that of patients with pT3 tumors (63%, P=0.018) or pT4 tumors (17%, P=0.000). Although the 3-year RFS of patients with pT3 tumors was greater than that of patients with pT4 tumors, the difference was not significant.
Successful down-staging of HCCs can be achieved in the majority of carefully selected patients by LRTs. Importantly, patients who are successfully down-staged and undergo LT may have a higher RFS rate.
在过去十年中，用于治疗肝细胞癌（HCC）的局部区域治疗（LRT）数量显著增加。许多超出米兰标准的 HCC 患者，一旦 HCC 成功降期，就可以接受肝移植（LT）。本回顾性研究旨在分析超出米兰标准的 HCC 患者在 LT 前接受 LRT 的结果。
我们分析了 2006 年 6 月至 2010 年 3 月期间治疗的 56 例患者：22 例符合米兰标准（T1+T2，39.3%），16 例 T3 肿瘤（28.6%），11 例 T4a 肿瘤（19.6%），7 例疑似肿瘤血管侵犯（T4b，12.5%）。所有患者均接受了术前 LRT，包括经导管动脉化疗栓塞、射频消融、经皮乙醇注射、肝切除术和/或微波凝固治疗。记录 LT 前成功降期的患者数量、LT 前使用的 LRT 类型以及 LT 后的结果。
11 例患者肿瘤坏死（pT0，19.6%）；6 例患者 pT1 肿瘤（10.7%），22 例患者 pT2 肿瘤（39.3%），6 例患者 pT3 肿瘤（10.7%），5 例患者 pT4a 肿瘤（8.9%），6 例患者 pT4b 肿瘤（10.7%）。39 例患者（69.6%）的组织病理学肿瘤降期，符合既定的米兰标准（pT0-2）。5 例 HCC 患者（8.9%）存在影像学证实的降期，肿瘤累及肝内静脉系统。23 例患者（41.1%）肿瘤稳定，10 例患者（17.9%）死亡。1、3 和 4 年生存率分别为 96%、73%和 61%，平均生存时间为 22.29+/-1.63 个月。6 例患者死于肿瘤复发。1、3 和 4 年无复发生存率（RFS）分别为 88%、75%和 66%。pT0-2 肿瘤患者的 3 年 RFS 为 82%，明显高于 pT3 肿瘤患者（63%，P=0.018）或 pT4 肿瘤患者（17%，P=0.000）。尽管 pT3 肿瘤患者的 3 年 RFS 高于 pT4 肿瘤患者，但差异无统计学意义。
通过 LRT 可使大多数经过精心选择的 HCC 患者成功降期。重要的是，成功降期并接受 LT 的患者可能具有更高的 RFS 率。
