Hepatobiliary-Pancreas Surgery and Liver Transplantation Division, Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 137-701, South Korea.
World J Gastroenterol. 2013 Aug 7;19(29):4737-44. doi: 10.3748/wjg.v19.i29.4737.
To investigate risk factors for hepatocellular carcinoma (HCC) recurrence after living donor liver transplantation (LDLT) and efficacy of various criteria.
From October 2000 to November 2011, 233 adult patients underwent LDLT for HCC at our institution. After excluding nine postoperative mortality cases, we analyzed retrospectively 224 patients. To identify risk factors for recurrence, we evaluated recurrence, disease-free survival (DFS) rate, survival rate, and various other factors which are based on the characteristics of both the patient and tumor. Additionally, we developed our own criteria based on our data. Next, we compared our selection criteria with various tumor-grading scales, such as the Milan criteria, University of California, San Francisco (UCSF) criteria, TNM stage, Barcelona Clinic Liver Cancer (BCLC) stage and Cancer of the Liver Italian Program (CLIP) scoring system. The median follow up was 68 (6-139) mo.
In 224 patients who received LDLT for HCC, 37 (16.5%) experienced tumor recurrence during the follow-up period. The 5-year DFS and overall survival rates after LDLT in all patients with HCC were 80.9% and 76.4%, respectively. On multivariate analysis, the tumor diameter {5 cm; P < 0.001; exponentiation of the B coefficient [Exp(B)], 11.89; 95%CI: 3.784-37.368} and alpha fetoprotein level [AFP, 100 ng/mL; P = 0.021; Exp(B), 2.892; 95%CI: 1.172-7.132] had significant influences on HCC recurrence after LDLT. Therefore, these two factors were included in our criteria. Based on these data, we set our selection criteria as a tumor diameter ≤ 5 cm and AFP ≤ 100 ng/mL. Within our new criteria (140/214, 65.4%), the 5-year DFS and overall survival rates were 88.6% and 81.8%, respectively. Our criteria (P = 0.001), Milan criteria (P = 0.009), and UCSF criteria (P = 0.001) showed a significant difference in DFS rate. And our criteria (P = 0.006) and UCSF criteria (P = 0.009) showed a significant difference in overall survival rate. But Milan criteria did not show significant difference in overall survival rate (P = 0.137). Among stages 0, A, B and C of BCLC, stage C had a significantly higher recurrence rate (P = 0.001), lower DFS (P = 0.001), and overall survival rate (P = 0.005) compared with the other stages. Using the CLIP scoring system, the group with a score of 4 to 5 showed a high recurrence rate (P = 0.023) and lower DFS (P = 0.011); however, the overall survival rate did not differ from that of the lower scoring group. The TNM system showed a trend of increased recurrence rate, decreased DFS, or survival rate according to T stage, albeit without statistical significance.
LDLT is considered the preferred therapeutic option in patients with an AFP level less than 100 ng/mL and a tumor diameter of less than 5 cm.
探讨活体肝移植（LDLT）后肝细胞癌（HCC）复发的危险因素和各种标准的疗效。
从 2000 年 10 月至 2011 年 11 月，我们机构对 233 例 HCC 成人患者进行了 LDLT。排除术后 9 例死亡病例后，我们回顾性分析了 224 例患者。为了确定复发的危险因素，我们评估了复发、无病生存率（DFS）率、生存率以及基于患者和肿瘤特征的其他各种因素。此外，我们根据自己的数据制定了自己的标准。接下来，我们将我们的选择标准与各种肿瘤分级标准（如米兰标准、加州大学旧金山分校标准、TNM 分期、巴塞罗那临床肝癌分期和肝癌意大利计划评分系统）进行了比较。中位随访时间为 68（6-139）个月。
在接受 LDLT 治疗 HCC 的 224 例患者中，有 37 例（16.5%）在随访期间发生肿瘤复发。所有 HCC 患者 LDLT 后的 5 年 DFS 和总生存率分别为 80.9%和 76.4%。多因素分析显示，肿瘤直径{5 cm；P < 0.001；B 系数的指数[Exp（B）]，11.89；95%CI：3.784-37.368}和甲胎蛋白水平[AFP，100 ng/mL；P = 0.021；Exp（B），2.892；95%CI：1.172-7.132}对 LDLT 后 HCC 复发有显著影响。因此，这两个因素被纳入我们的标准。根据这些数据，我们将选择标准设定为肿瘤直径≤5 cm 和 AFP≤100 ng/mL。在我们的新标准（140/214，65.4%）中，5 年 DFS 和总生存率分别为 88.6%和 81.8%。我们的标准（P = 0.001）、米兰标准（P = 0.009）和 UCSF 标准（P = 0.001）在 DFS 率方面有显著差异。我们的标准（P = 0.006）和 UCSF 标准（P = 0.009）在总生存率方面有显著差异。但米兰标准在总生存率方面没有显著差异（P = 0.137）。在 BCLC 的 0、A、B 和 C 期，C 期的复发率明显较高（P = 0.001），DFS（P = 0.001）和总生存率（P = 0.005）较低。使用 CLIP 评分系统，评分 4-5 分的组复发率较高（P = 0.023），DFS 较低（P = 0.011）；然而，总生存率与较低评分组无差异。TNM 系统显示 T 分期越高，复发率、DFS 或生存率越高，尽管无统计学意义。
对于 AFP 水平<100ng/ml 和肿瘤直径<5cm 的患者，LDLT 被认为是首选治疗方案。
