Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, China.
J Gastrointest Surg. 2012 Nov;16(11):2120-5. doi: 10.1007/s11605-012-2019-y. Epub 2012 Sep 5.
Various downstaging therapies were introduced to liver recipients who could not meet the relative criteria for liver transplantation, and many endpoints were reported. The most common criteria used were the Milan criteria and the University of California, San Francisco (UCSF) criteria. However, no comparison was made between them, and we attempted to find possible differences between the living donor liver transplantation (LDLT) patients who met the Milan criteria and those who met the UCSF criteria after accepting preoperative downstaging therapies.
We performed a retrospective study of all 72 patients at our center from January 2003 to March 2009 who were diagnosed with advanced hepatocellular carcinoma but accepted various downstaging therapies. Some patients met the Milan criteria (group 1), and some met the UCSF criteria (group 2) but not the Milan criteria. We collected the data from the two groups and then compared the preoperative demographic data, downstaging therapies, intraoperative data from LDLT, and the recovery and complications after LDLT. Survival rates were compared using Kaplan-Meier analysis.
Only 44 patients (61.1 %) met the criteria for liver transplantation, 21 cases met the Milan criteria (group 1), and 23 cases met the UCSF criteria (group 2) but not the Milan criteria. All of the 44 patients accepted right lobe living liver donor liver transplantation in our center. The difference in the baseline characteristics between the two groups did not reach statistical significance. The mean number of downstaging treatments per patient was 1.81 ± 0.35 in group 1 and 1.83 ± 0.41 in group 2 (P = 0.928). Most of the patients received only one downstaging treatment, and transcatheter arterial chemoembolization (TACE) was the most common downstaging therapy. Four patients suffered complications after downstaging therapies: intra-abdominal hemorrhage after right hepatectomy, upper gastrointestinal hemorrhage after TACE, biliary fistula after resection, and hand-foot syndrome after taking sorafenib. All complications after LDLT, classified according to the Clavien-Dindo system, were compared within the two groups, and the calculated score of the complications in group 1 was 1.48 ± 1.63, which was greater than that of group 2 (1.39 ± 1.64), but this difference did not reach statistical significance (P = 0.865). The 1-, 3-, and 5-year survival rates were 90.4, 76.2, and 71.4 % in group 1 and 91.3, 73.9, and 69.6 % in group 2, respectively (P > 0.05). Seven patients (three in group 1 and four in group 2) had tumor recurrence after a median follow-up period of 72 months. The pathology findings were not different between the two groups.
Recipients who meet the Milan or UCSF criteria after accepting successful preoperative downstaging therapy in LDLT can achieve the same result.
为满足肝移植相对标准而不能进行肝移植的患者引入了各种降期治疗，报道了许多终点。最常用的标准是米兰标准和加利福尼亚大学旧金山分校（UCSF）标准。然而，两者之间没有进行比较，我们试图发现接受术前降期治疗后符合米兰标准的活体供肝移植（LDLT）患者和符合 UCSF 标准但不符合米兰标准的患者之间可能存在的差异。
我们对 2003 年 1 月至 2009 年 3 月期间在我院接受诊断为晚期肝细胞癌但接受各种降期治疗的 72 例患者进行了回顾性研究。一些患者符合米兰标准（组 1），一些患者符合 UCSF 标准（组 2）但不符合米兰标准。我们收集了两组的数据，然后比较了术前人口统计学数据、降期治疗、LDLT 术中数据以及 LDLT 后的恢复和并发症。使用 Kaplan-Meier 分析比较生存率。
只有 44 例患者（61.1%）符合肝移植标准，21 例符合米兰标准（组 1），23 例符合 UCSF 标准（组 2）但不符合米兰标准。所有 44 例患者均在我院接受右半肝活体供肝肝移植。两组基线特征的差异无统计学意义。组 1 中每名患者降期治疗的平均次数为 1.81±0.35，组 2 为 1.83±0.41（P=0.928）。大多数患者仅接受一次降期治疗，经导管动脉化疗栓塞（TACE）是最常见的降期治疗方法。4 例患者在降期治疗后出现并发症：右肝切除术后腹腔内出血、TACE 后上消化道出血、切除术后胆瘘、服用索拉非尼后手足综合征。根据 Clavien-Dindo 系统对 LDLT 后的所有并发症进行比较，组 1 的并发症评分（1.48±1.63）高于组 2（1.39±1.64），但差异无统计学意义（P=0.865）。组 1 的 1、3 和 5 年生存率分别为 90.4%、76.2%和 71.4%，组 2 分别为 91.3%、73.9%和 69.6%（P>0.05）。7 例患者（组 1 3 例，组 2 4 例）在中位随访 72 个月后出现肿瘤复发。两组的病理发现无差异。
接受成功的术前降期治疗后符合米兰或 UCSF 标准的受者可获得相同的结果。
