Section of Transplantation, Department of General Surgery, University of Utah, Salt Lake City, UT 75390, USA.
Liver Transpl. 2012 Apr;18(4):423-33. doi: 10.1002/lt.23385.
Current liver allocation policy in the United States grants liver transplant candidates with stage T2 hepatocellular carcinoma (HCC) a priority Model for End-Stage Liver Disease (MELD) score of 22, regardless of age. Because advanced age may portend an increase in all-cause mortality after transplantation for any diagnosis, the aim of this study was to examine overall posttransplant survival in elderly patients with HCC versus younger cohorts. Based on Organ Procurement and Transplantation Network data, Kaplan-Meier 5-year survival rates were compared. Recipients undergoing primary liver transplantation were stratified into cohorts based on age (<70 or ≥ 70 years) and the receipt of MELD exception points for HCC. Log-rank and Wilcoxon tests were used for statistical comparisons. In 2009, 143 transplants were performed for patients who were 70 years old or older. Forty-two percent of these patients received a MELD exception for HCC. Regardless of the diagnosis, the overall survival rate was significantly attenuated for the septuagenarians versus the younger cohort. After 5 years of follow-up, this disparity exceeded 10% to 15% depending on the populations being compared. The 1-, 2-, 3-, 4-, and 5-year actuarial survival rates were 88.4%, 83.2%, 79.6%, 76.1%, and 72.7%, respectively, for the patients who were younger than 70 years and 81.1%, 73.8%, 67.1%, 61.9%, and 55.2%, respectively, for the patients who were 70 years old or older. Five-year survival was negatively affected for patients with HCC who were younger than 70 years; this disparity was not observed for patients with HCC who were 70 years old or older. In conclusion, although patients who are 70 years old or older compose a small fraction of transplant recipients in the United States, patients in this group undergoing transplantation for HCC form an even smaller subset. Overall, transplantation in this age group yields outcomes inferior to those for younger cohorts. However, unlike patients who are less than 70 years old and receive MELD exception points, overall liver transplant survival is not affected by HCC at an advanced age.
目前,美国的肝脏分配政策给予 T2 期肝细胞癌(HCC)患者一个优先的终末期肝病模型(MELD)评分 22,无论其年龄大小。由于高龄可能预示着任何诊断的移植后全因死亡率增加,因此本研究旨在比较老年 HCC 患者与年轻患者群体的总体移植后生存情况。基于器官获取与移植网络的数据,比较了 Kaplan-Meier 5 年生存率。根据年龄(<70 岁或≥70 岁)和是否因 HCC 获得 MELD 例外分数,将接受原发性肝移植的受者分为队列。对数秩和 Wilcoxon 检验用于统计比较。2009 年,有 143 例 70 岁或以上的患者接受了肝移植。其中 42%的患者因 HCC 获得了 MELD 例外。无论诊断如何,70 岁以上的患者的总体生存率明显低于年轻队列。随访 5 年后,根据比较的人群,这种差异超过了 10%至 15%。1、2、3、4 和 5 年的实际生存率分别为<70 岁的患者为 88.4%、83.2%、79.6%、76.1%和 72.7%,而≥70 岁的患者分别为 81.1%、73.8%、67.1%、61.9%和 55.2%。对于<70 岁的 HCC 患者,5 年生存率受到负面影响;而对于≥70 岁的 HCC 患者,这种差异并不明显。总之,尽管美国的肝移植受者中 70 岁或以上的患者占少数,但在这个年龄组中,因 HCC 接受移植的患者则更少。总的来说,这个年龄组的移植结果不如年轻患者群体。然而,与<70 岁且获得 MELD 例外分数的患者不同,高龄 HCC 不会影响整体肝移植生存率。