Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY 10029, USA.
HPB (Oxford). 2013 Feb;15(2):134-41. doi: 10.1111/j.1477-2574.2012.00548.x. Epub 2012 Aug 30.
The relative roles of liver resection (LR) and liver transplantation (LT) in the treatment of a solitary hepatocellular carcinoma (HCC) remain unclear. This study was conducted to provide a retrospective intention-to-treat comparison of these two curative therapies.
Records maintained at the study centre for all patients treated with LR or listed for LT for hepatitis C-associated HCC between January 2002 and December 2007 were reviewed. Inclusion criteria required: (i) an initial diagnosis of a solitary HCC lesion measuring ≤ 5 cm, and (ii) Child-Pugh class A or B cirrhosis. The primary endpoint analysed was intention-to-treat survival.
A total of 75 patients were listed for transplant (LT-listed group) and 56 were resected (LR group). Of the 75 LT-listed patients, 23 (30.7%) were never transplanted because they were either removed from the waiting list (n = 13) or died (n = 10). Intention-to-treat median survival was superior in the LR group compared with the LT-listed group (61.8 months vs. 30.6 months), but the difference did not reach significance. Five-year recurrence was higher in the LR group than in the 52 LT patients (71.5% vs. 30.5%; P < 0.001).
In the context of limited donor organ availability, partial hepatectomy represents an efficacious primary approach in properly selected patients with hepatitis C-associated HCC.
对于单发肝细胞癌（HCC）的治疗，肝切除术（LR）和肝移植（LT）的相对作用仍不清楚。本研究旨在对这两种治愈性治疗方法进行回顾性意向治疗比较。
回顾性分析 2002 年 1 月至 2007 年 12 月期间在研究中心接受 LR 或 LT 治疗丙型肝炎相关 HCC 的所有患者的记录。纳入标准要求：（i）最初诊断为单发 HCC 病变，直径≤5cm，（ii）Child-Pugh 分级为 A 或 B 级肝硬化。主要分析终点为意向治疗生存。
共有 75 名患者被列入移植名单（LT 组），56 名患者接受了手术切除（LR 组）。在 75 名 LT 组患者中，有 23 名（30.7%）从未接受过移植，因为他们被从等待名单中除名（n=13）或死亡（n=10）。LR 组的意向治疗中位生存期优于 LT 组（61.8 个月 vs. 30.6 个月），但差异无统计学意义。LR 组的 5 年复发率高于 52 名 LT 患者（71.5% vs. 30.5%；P<0.001）。
在供体器官有限的情况下，对于适当选择的丙型肝炎相关 HCC 患者，部分肝切除术是一种有效的初始治疗方法。
