Nemes B, Gelley F, Piros L, Zádori G, Görög D, Fehérvári I, Kóbori L, Sárváry E, Nagy P, Kiss A, Doros A
Clinic of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.
Transplant Proc. 2011 May;43(4):1272-4. doi: 10.1016/j.transproceed.2011.03.077.
In addition to hepatitis C, hepatocellular carcinoma. is a leading indication for orthotopic liver transplantation (OLT). The indications for OLT in HCC remains a topic of debate. The successful Milan criteria are still accepted as the gold standard to select candidates with a good chance for long-term survival. The Hungarian Liver Transplant Program launched in 1995 reached 45 OLT/year in 2010. Among 412 first OLTs, there were 49 cases of a malignant tumor, including 41 among which the indication was the tumor. Of the 412 patients, 154 (37.4%) were hepatitic C virus (HCV) positive, including 29 with HCC and 23 cases in which HCC was the indication itself. Half of the HCC patients were within the Milan criteria; 50% exceeded the criteria. We observed a solitary HCC in 36% of cases: 2 foci in 18%; 3 in 7%, 4 in 14%, and ≥5 in 25%. Only 12 patients underwent a "down-staging" treatment before OLT: 8 radiofrequency ablation (RFA) and 4 transarterial chemoembolization (TACE). Cumulative 1-, 3-, and 5-year patient survivals were 62%, 54%, and 43%, respectively in HCC/HCV-positive patients and they were 74%, 67%, and 61% among non-HCC HCV-positive subjects. The cumulative HCC patient survival rates of 64%, 64%, and 53% among Milan criteria were superior to those of 57%, 40%, and 27% among subjects exceeding the Milan criteria (P=.01). Pre-OLT "down-staging" treatment increased the 1-year patient survival from 64% to 70%; however, it did not affect the long-term results. Among items of the Milan criteria tumor size had less impact on outcomes then number of foci. The majority of cases who exceeded the Milan criteria had been transplanted before 2003. Our results suggested that the Milan criteria should be applied for the selection of candidates in order to promise good survival after OLT for HCC.
除丙型肝炎外，肝细胞癌是原位肝移植（OLT）的主要适应证。肝癌患者进行OLT的适应证仍是一个有争议的话题。成功的米兰标准仍然被视为选择有长期生存良好机会的候选者的金标准。1995年启动的匈牙利肝移植项目在2010年达到每年45例OLT。在412例首次OLT中，有49例为恶性肿瘤，其中41例的适应证为肿瘤。在412例患者中，154例（37.4%）丙型肝炎病毒（HCV）阳性，其中29例患有肝癌，23例以肝癌为适应证本身。一半的肝癌患者符合米兰标准；50%超出标准。我们观察到36%的病例为单个肝癌病灶：18%为2个病灶；7%为3个病灶，14%为4个病灶，25%为≥5个病灶。只有12例患者在OLT前接受了“降期”治疗：8例接受射频消融（RFA），4例接受经动脉化疗栓塞（TACE）。肝癌/HCV阳性患者的1年、3年和5年累积生存率分别为62%、54%和43%，非肝癌HCV阳性患者分别为74%、67%和61%。米兰标准组肝癌患者的累积生存率为64%、64%和53%，优于超出米兰标准组的57%、40%和27%（P = 0.01）。OLT前的“降期”治疗使1年患者生存率从64%提高到70%；然而，它并未影响长期结果。在米兰标准的各项指标中，肿瘤大小对预后的影响小于病灶数量。大多数超出米兰标准的病例在2003年前接受了移植。我们的结果表明，应采用米兰标准来选择候选者，以确保肝癌患者OLT后有良好的生存率。
