Department of General Surgery and Organ Transplantation, Umberto I Hospital, Sapienza University, Rome, Italy.
Clin Transplant. 2012 Mar-Apr;26(2):E125-31. doi: 10.1111/j.1399-0012.2011.01572.x. Epub 2011 Dec 22.
In the last several years, there has been no agreement on how to possibly expand the Milan criteria (MC) in the selection of patients with hepatocellular carcinoma (HCC) for listing for liver transplant (LT). The aim of the study is to evaluate morphological and biological tumor parameters to identify new expanded criteria for the selection of patients with HCC as candidates for LT.
We retrospectively analyzed 158 consecutive patients with HCC who underwent LT.
Twelve (7.6%) recurrences were observed. At multivariate analysis, alpha-fetoprotein (AFP) >400 ng/mL (odds ratio [OR] 8.4, p<0.01) and total tumor diameter (TTD) >8 cm (OR 7.4, p=0.01) were the strongest predictors for recurrence. AFP-TTD criteria resulted in a low five-yr recurrence rate (4.9%) and an increased number of LT compared with the MC (22.2% increase). The five-yr disease-free survival rate was 74.4% in AFP-TTD criteria in patients, with a higher effectiveness in stratifying the cohort with respect to the MC.
Both AFP and TTD are good independent predictors of HCC recurrence. Their combination appears to obtain a better selection of candidates for LT without worsening patient survival and recurrence rates. This approach allows for an increase in the number of potentially transplantable patients.
在过去的几年中，对于如何扩展米兰标准（MC）以选择肝细胞癌（HCC）患者进行肝移植（LT），尚无共识。本研究旨在评估形态学和生物学肿瘤参数，以确定新的扩展标准，选择 HCC 患者作为 LT 的候选者。
我们回顾性分析了 158 例接受 LT 的 HCC 连续患者。
观察到 12 例（7.6%）复发。多因素分析显示，甲胎蛋白（AFP）>400ng/mL（优势比[OR]8.4，p<0.01）和总肿瘤直径（TTD）>8cm（OR 7.4，p=0.01）是复发的最强预测因子。与 MC 相比，AFP-TTD 标准导致 5 年复发率较低（4.9%），LT 数量增加（增加 22.2%）。在 AFP-TTD 标准中，患者的 5 年无病生存率为 74.4%，与 MC 相比，在分层队列方面具有更高的有效性。
AFP 和 TTD 都是 HCC 复发的良好独立预测因子。它们的组合似乎可以更好地选择 LT 的候选者，而不会恶化患者的生存率和复发率。这种方法允许增加潜在可移植患者的数量。
