Isik B, Ince V, Karabulut K, Kayaalp C, Yilmaz S
Department of Surgery, Liver Transplantation Institute, Inonu University, Malatya, Turkey.
Transplant Proc. 2012 Jul-Aug;44(6):1713-6. doi: 10.1016/j.transproceed.2012.05.033.
Liver transplantation is a widely accepted modality in the treatment of hepatocellular carcinoma (HCC). In our center, patients with HCC limited to the liver without macrovascular invasion are accepted as candidates for living donor liver transplantation (LDLT). The aim of this study was to describe the patient characteristics and outcomes at a single institution to analyze the impact of our criteria on the survival of HCC patients.
We reviewed the medical records of all HCC (n = 105) patients who underwent liver transplantation in our institution. We excluded deaths in the early postoperative period and deceased donor liver transplantation (DDLT) patients, leaving 74 subjects (65 males and 9 female). Their median age was 53 years (range, 19-69). Univariate Kaplan-Meier and multivariate Cox proportional hazards models were used to analyze overall and disease-free survivals.
Thirty-two (43%) patients were within the Milan criteria, and 42 (57%) exceeded them. One- and 2-year overall survival rates for patients within versus exceeding the Milan criteria were 72% versus 68% and 61% versus 58%, respectively. One- and 2-year disease-free survival rates for patients within versus exceeding the Milan criteria were 72% versus 68% and 60% versus 55%, respectively (P > .05). Tumor recurrence rates for patients within versus exceeding the Milan criteria were 0% versus 36%, respectively (P = .0002). Alpha-fetoprotein level was the only predictor of overall survival; alpha-fetoprotein level and tumor differentiation were predictors of disease-free survival.
Although higher recurrence rates have been observed among patients exceeding the Milan criteria, LDLT is the only treatment option for the patients in countries with limited sources of cadaveric organs. As a general principle, we believe that the use of cadaveric donor liver grafts is not suitable for patients who exceed these criteria.
肝移植是治疗肝细胞癌(HCC)广泛接受的一种方式。在我们中心,局限于肝脏且无大血管侵犯的HCC患者被视为活体肝移植(LDLT)的候选者。本研究的目的是描述单一机构中患者的特征和结局,以分析我们的标准对HCC患者生存的影响。
我们回顾了在我们机构接受肝移植的所有HCC患者(n = 105)的病历。我们排除了术后早期死亡患者和尸体供肝肝移植(DDLT)患者,留下74名受试者(65名男性和9名女性)。他们的中位年龄为53岁(范围19 - 69岁)。采用单因素Kaplan-Meier法和多因素Cox比例风险模型分析总生存期和无病生存期。
32例(43%)患者符合米兰标准,42例(57%)超出该标准。符合与超出米兰标准患者的1年和2年总生存率分别为72%对68%和61%对58%。符合与超出米兰标准患者的1年和2年无病生存率分别为72%对68%和60%对55%(P > 0.05)。符合与超出米兰标准患者的肿瘤复发率分别为0%对36%(P = 0.000)。甲胎蛋白水平是总生存期的唯一预测因素;甲胎蛋白水平和肿瘤分化是无病生存期的预测因素。
尽管超出米兰标准的患者复发率较高,但在尸体器官来源有限的国家,LDLT是这些患者的唯一治疗选择。作为一般原则,我们认为尸体供肝移植不适用于超出这些标准的患者。