晚期肝细胞癌患者活体肝移植的扩展标准
Extended criteria for living donor liver transplantation in patients with advanced hepatocellular carcinoma.
作者信息
Choi H J, Kim D G, Na G H, Hong T H, You Y K
机构信息
Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
出版信息
Transplant Proc. 2012 Mar;44(2):399-402. doi: 10.1016/j.transproceed.2012.01.019.
BACKGROUND
The purpose of this study was to evaluate the possibility of expanding the selection criteria in living donor liver transplantation (LDLT) to treat hepatocellular carcinoma (HCC).
METHODS
From October 2000 to December 2010, we retrospectively analyzed 71 patients who had undergone LDLT beyond the Milan criteria (MC), among the entire cohort of 199 HCC patients. We evaluated the tumor biology as well as overall and disease-free survival (DFS), seeking to identify risk factors for recurrence. The median follow-up was 37 months (range 5-124).
RESULTS
Among the 71 patients beyond the MC were 18 recurrences and 30 deaths. Their 5-year overall and DFS rates were 52.3% and 67.7%, respectively. On multivariate analysis, tumor diameter, tumor number, and E-S grade significantly influenced overall and DFS. According to our new criteria (size≤7 cm, number≤7), 86% of our patients would be included compared with 64% using MC. Five-year DFS and overall survival rates according to our criteria were comparable with the MC: 86.8% and 72.3% versus 86.8% and 73.4%, respectively.
CONCLUSION
Our criteria appear to achieve useful cut-off values beyond the MC.
背景
本研究旨在评估扩大活体肝移植（LDLT）选择标准以治疗肝细胞癌（HCC）的可能性。
方法
2000年10月至2010年12月，我们回顾性分析了199例HCC患者中71例接受了超出米兰标准（MC）的LDLT患者。我们评估了肿瘤生物学以及总生存率和无病生存率（DFS），以寻找复发的危险因素。中位随访时间为37个月（范围5 - 124个月）。
结果
在71例超出MC标准的患者中，有18例复发，30例死亡。他们的5年总生存率和DFS率分别为52.3%和67.7%。多因素分析显示，肿瘤直径、肿瘤数量和E-S分级对总生存率和DFS有显著影响。根据我们的新标准（大小≤7 cm，数量≤7个），86%的患者符合标准，而使用MC标准时为64%。根据我们的标准，5年DFS率和总生存率与MC标准相当：分别为86.8%和72.3%，而MC标准为86.8%和73.4%。
结论
我们制定的标准似乎在MC标准之外实现了有效的临界值。
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