Chan See Ching, Fan Sheung Tat, Chok Kenneth S H, Cheung Tan To, Chan Albert C Y, Fung James Y Y, Poon Ronnie T P, Lo Chung Mau
State Key Laboratory for Liver Research, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China ; Department of Surgery, The University of Hong Kong, Hong Kong, China.
Department of Surgery, The University of Hong Kong, Hong Kong, China.
Hepatol Int. 2011 Oct 21;6(3):646-656. doi: 10.1007/s12072-011-9318-3. eCollection 2012 Jun.
Microvascular invasion of hepatocellular carcinoma (HCC) is considered a poor prognostic factor of liver resection (LR) and liver transplantation (LT), but its significance for lesions within the up-to-7 criteria is unclear. This study investigated the survival benefit of primary LT against LR for HCC with microvascular invasion and within the up-to-7 criteria.
Adult patients who underwent LR or LT as the primary treatment for HCC were included for study. Patients with prior local ablation, neoadjuvant systemic chemotherapy, targeted therapy, positive resection margin, or metastatic spread were excluded.
There were 471 LR patients and 95 LT recipients (70 with living donor, 25 with deceased donor). Seventy-seven (81.1%) LT recipients had HCC within the up-to-7 criteria. Twenty-five (26.3%) LT recipients had HCC with either macrovascular ( = 4) or microvascular ( = 21) invasion. The 5-year survival rate was 85.7% for LT recipients with HCC within the up-to-7 criteria, unaffected by the presence or absence of vascular invasion (88.2 vs. 85.1%). The rate was comparable with that of LR patients with HCC without vascular invasion (81.2%, 0.227), but far superior to that of LR patients with lesions with vascular invasion (50.0%, < 0.0001). Overall survivals were compromised by multiple tumors [odds ratio (OR) 1.902, confidence interval (CI) 1.374-2.633, = 0.0001], vascular invasion (OR 2.678, CI 1.952-3.674, < 0.0001), blood transfusion (OR 2.046, CI 1.337-3.131, = 0.001), and being beyond the up-to-7 criteria (OR 1.457, CI 1.041-2.037, = 0.028). LT was a favorable factor for survival (OR 0.243, CI 0.130-0.454, < 0.0001).
Primary LT for HCC with microvascular invasion and within the up-to-7 criteria doubled the chance of cure as compared with LR.
肝细胞癌（HCC）的微血管侵犯被认为是肝切除（LR）和肝移植（LT）预后不良的因素，但其对符合米兰标准内病变的意义尚不清楚。本研究调查了微血管侵犯且符合米兰标准的HCC患者接受原发性LT与LR相比的生存获益情况。
纳入接受LR或LT作为HCC主要治疗方法的成年患者进行研究。排除既往接受过局部消融、新辅助全身化疗、靶向治疗、手术切缘阳性或有转移扩散的患者。
有471例LR患者和95例LT受者（70例活体供肝，25例尸体供肝）。77例（81.1%）LT受者的HCC符合米兰标准。25例（26.3%）LT受者的HCC存在大血管（n = 4）或微血管（n = 21）侵犯。符合米兰标准的LT受者中，5年生存率为85.7%，不受血管侵犯情况的影响（88.2%对85.1%）。该生存率与无血管侵犯的LR患者相当（81.2%，P = 0.227），但远高于有血管侵犯病变的LR患者（50.0%，P < 0.0001）。多肿瘤[比值比（OR）1.902，置信区间（CI）1.374 - 2.633，P = 0.0001]、血管侵犯（OR 2.678，CI 1.952 - 3.674，P < 0.0001）、输血（OR 2.046，CI 1.337 - 3.131，P = 0.001）以及超出米兰标准（OR 1.457，CI 1.041 - 2.037，P = 0.028）会损害总体生存。LT是生存的有利因素（OR 0.243，CI 0.130 - 0.454，P < 0.0001）。
对于微血管侵犯且符合米兰标准的HCC患者，原发性LT与LR相比，治愈机会增加了一倍。
