肝细胞癌患者活体肝移植的两步选择标准。

Two-step selection criteria for living donor liver transplantation in patients with hepatocellular carcinoma.

作者信息

Yoshizumi T, Ikegami T, Toshima T, Harimoto N, Uchiyama H, Soejima Y, Yamashita Y, Shirabe K, Maehara Y

机构信息

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

出版信息

Transplant Proc. 2013 Nov;45(9):3310-3. doi: 10.1016/j.transproceed.2013.05.001.

DOI:10.1016/j.transproceed.2013.05.001

PMID:24182807

Abstract

We have proposed risk factors for tumor recurrence, such as tumor nodule ≥ 5 cm and des-gamma-carboxy prothrombin ≥ 300 mAU/mL after living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC). The aim of this study was to clarify the risk factors for HCC recurrence and mortality within our criteria. We enrolled 152 adult recipients who had undergone LDLT for end-stage liver disease with HCC who met our criteria. The recurrence-free survival rates after LDLT were calculated. Risk factors for tumor recurrence were identified. On univariate analysis, factors affecting recurrence-free survival were pretransplant treatment for HCC, neutrophil-to-lumphocyte ratio (NLR) >4, alpha-fetoprotein ≥ 400 ng/mL, ≥ 5 nodules, and bilobar tumor distribution. Multivariate analysis identified that NLR >4 and ≥ 5 nodules were independent risk factors for tumor recurrence after LDLT (P = .003 and P = .002, respectively). Two-step selection criteria enable selection of patients who have high-risk of tumor recurrence.

摘要

我们已经提出了肿瘤复发的危险因素，例如在活体肝移植（LDLT）治疗肝细胞癌（HCC）后，肿瘤结节≥5 cm以及去γ-羧基凝血酶原≥300 mAU/mL。本研究的目的是明确在我们的标准范围内HCC复发和死亡的危险因素。我们纳入了152例符合我们标准的因终末期肝病合并HCC而接受LDLT的成年受者。计算了LDLT后的无复发生存率。确定了肿瘤复发的危险因素。单因素分析显示，影响无复发生存的因素包括HCC的移植前治疗、中性粒细胞与淋巴细胞比值（NLR）>4、甲胎蛋白≥400 ng/mL、结节≥5个以及肿瘤双叶分布。多因素分析确定NLR>4和结节≥5个是LDLT后肿瘤复发的独立危险因素（P值分别为0.003和0.002）。两步选择标准能够筛选出肿瘤复发高危患者。