Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
Liver Transpl. 2012 Apr;18(4):434-43. doi: 10.1002/lt.23394.
Candidates with hepatocellular carcinoma (HCC) within the Milan criteria (MC) receive standardized Model for End-Stage LIver Disease (MELD) exception points because of the projected risk of tumor expansion beyond the MC. Exception points at listing are meant to be equivalent to a 15% rusj if 90-day mortality, with additional points granted every 3 months, equivalent to a 10% increased morality risk. We analyzed the United Network for Organ Sharing database (January 1, 2005 to May 31, 2009) to compare the 90-day waitlist outcomes of HCC candidates and non-HCC candidates with similar MELD scores. Two hundred fifty-nine HCC candidates (4.1%) who were initially listed with 22 MELD exception points were removed because of death or clinical deterioration within 90 days of listing, whereas 283 non-HCC candidates (11.0%) with initial laboratory MELD scores of 21 to 23 were removed. Ninety-three HCC candidates (4.6%) with 25 exception points (after 3-6 months of waiting) were removed because of death or clinical deterioration within 90 days, whereas 805 non-HCC candidates (17.3%) with laboratory MELD scores of 24 to 26 were removed. Twenty HCC candidates (3.0%) with 28 exception points (after 6-9 months of waiting) were removed for death or clinical deterioration within 90 days, whereas 646 non-HCC candidates (23.6%) with laboratory MELD scores of 27 to 29 were removed. In multivariate logistic regression models, HCC candidates had significantly lower 90-day odds of waitlist removal for death or clinical deterioration (P < 0.001). Over time, the risk of waitlist removal for death or clinical deterioration was unchanged for HCC candidates (P = 0.17), whereas it increased significantly for non-HCC candidates. The current allotment of HCC exception points should be re-evaluated because of the stable risk of waitlist dropout for these candidates.
符合米兰标准 (MC) 的肝细胞癌 (HCC) 患者因肿瘤预计会超出 MC 而扩张，会获得标准化的终末期肝病模型 (MELD) 例外积分。在列表中的例外积分旨在等同于 90 天死亡率的 15%，每 3 个月增加一次积分，相当于死亡率风险增加 10%。我们分析了器官共享联合网络数据库 (2005 年 1 月 1 日至 2009 年 5 月 31 日)，以比较具有相似 MELD 评分的 HCC 候选人和非 HCC 候选者的 90 天候补名单结果。由于在列表中列出后的 90 天内死亡或临床恶化，259 名 HCC 候选者 (4.1%) 最初被列入，他们有 22 个 MELD 例外积分，而 283 名非 HCC 候选者 (11.0%) 最初实验室 MELD 评分为 21 至 23，也因同样原因被移除。93 名 HCC 候选者 (4.6%) 有 25 个例外积分 (等待 3-6 个月后)，由于在 90 天内死亡或临床恶化而被移除，而 805 名非 HCC 候选者 (17.3%) 实验室 MELD 评分为 24 至 26，也因同样原因被移除。20 名 HCC 候选者 (3.0%) 有 28 个例外积分 (等待 6-9 个月后)，由于在 90 天内死亡或临床恶化而被移除，而 646 名非 HCC 候选者 (23.6%) 实验室 MELD 评分为 27 至 29，也因同样原因被移除。在多变量逻辑回归模型中，HCC 候选者在 90 天内等待名单上因死亡或临床恶化而被移除的可能性明显较低 (P < 0.001)。随着时间的推移，HCC 候选者因死亡或临床恶化而被移除的等待名单风险保持不变 (P = 0.17)，而非 HCC 候选者的风险则显著增加。由于这些候选者等待名单淘汰的风险稳定，应重新评估 HCC 例外积分的分配。
