Hwang S, Moon D-B, Ahn C-S, Kim K-H, Ha T-Y, Song G-W, Jung D-H, Park G-C, Lee H C, Lee Y S, Chung Y-H, Abdulkarim B A, Lee S-G
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea.
Transplant Proc. 2013 Oct;45(8):3076-84. doi: 10.1016/j.transproceed.2013.08.068.
This study sought to establish an actual risk-based long-term screening protocol for hepatocellular carcinoma (HCC) recurrence after liver transplantation (OLT).
The study was a retrospective review of medical records from 334 HCC patients who underwent primary living donor OLT and followed up for at least 5 years.
Overall 10-year patient survival rate was 67.5%, with a 4.8% perioperative mortality. HCC recurred in 68/318 (21.4%) surviving patients over a mean follow-up of 77 months. HCC recurrence was 20.7% at 5 and 22.2% at 10 years. Annual recurrence rates were 11.4%, 6.6%, and 2.0% during the first, second, and third years, respectively. Among patients within Milan criteria, the annual incidence of HCC recurrence was highest during the first 3 years; thereafter only 6 sporadic recurrences were observed during next 8 years. Among subjects beyond Milan criteria, recurrence was common during, but not after 3 years. In 43 patients (63.2%) increased alpha-fetoprotein (AFP) was an initial indication to perform further imaging studies to diagnosis recurrence, whereas they were detected incidentally on protocol screening imaging among another 25 patients (36.8%) in the absence of an AFP rise. There was a close correlation between pretransplant AFP level and AFP increase after HCC recurrence.
Patients beyond the Milan criteria require frequent tumor marker tests and imaging studies over the first 3 years; and those within Milan criteria require 10-years to follow-up primarily with tumor marker tests.
本研究旨在建立一个基于实际风险的肝移植（OLT）后肝细胞癌（HCC）复发的长期筛查方案。
本研究对334例行初次活体供肝OLT并随访至少5年的HCC患者的病历进行回顾性分析。
患者10年总生存率为67.5%，围手术期死亡率为4.8%。318例存活患者中，68例（21.4%）在平均77个月的随访期内出现HCC复发。HCC复发率在5年时为20.7%，10年时为22.2%。第1、2、3年的年复发率分别为11.4%、6.6%和2.0%。符合米兰标准的患者中，HCC复发的年发生率在最初3年最高；此后，在接下来的8年中仅观察到6例散发性复发。超出米兰标准的患者中，复发在3年内较为常见，但3年后则不然。43例患者（63.2%）甲胎蛋白（AFP）升高是进行进一步影像学检查以诊断复发的初始指征，而另外25例患者（36.8%）在AFP未升高的情况下，在方案筛查影像学检查中偶然被发现复发。移植前AFP水平与HCC复发后AFP升高之间存在密切相关性。
超出米兰标准的患者在最初3年需要频繁进行肿瘤标志物检测和影像学检查；而符合米兰标准的患者主要需要进行10年的肿瘤标志物检测随访。
