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肝切除术后复发性肝细胞癌的挽救性肝移植:米兰标准和杭州标准的回顾性研究

Salvage liver transplantation for recurrent hepatocellular carcinoma after liver resection: retrospective study of the Milan and Hangzhou criteria.

作者信息

Hu Zhenhua, Zhou Jie, Li Zhiwei, Xiang Jie, Qian Ze, Wu Jian, Zhang Min, Zheng Shusen

机构信息

Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China ; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Zhejiang Province, Hangzhou, China ; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou, China.

出版信息

PLoS One. 2014 Jan 27;9(1):e87222. doi: 10.1371/journal.pone.0087222. eCollection 2014.

Abstract

BACKGROUND

Salvage liver transplantation (SLT) has recently been proposed for recurrent hepatocellular carcinoma after liver resection; however, criteria for candidate assessment in SLT have not been thoroughly evaluated.

METHODS AND FINDINGS

We retrospectively analyzed outcomes and factors affecting survival of 53 recipients who received SLT in the Liver Transplantation Center, The First Affiliated Hospital of Zhejiang University between 2004 and 2012. Thirty recipients fulfilled the Hangzhou criteria, of which 16 also fulfilled the Milan criteria, while the remaining 23 exceeded both criteria. The 1-year, 3-year and 5-year overall survival rates and tumor-free survival rates were both superior in patients fulfilling Milan or Hangzhou criteria compared with those exceeding the criteria. For recipients outside Milan criteria but within Hangzhou criteria, the 1-year, 3-year overall survival rates were 70.1%, 70.1%, similar to recipients within Milan criteria, with the 1-year, 3-year and 5-year overall survival of 93.8%%, 62.1% and 62.1% (P = 0.586). The tumor-free survival rates were also similar between these two subgroups, with 51.9% and 51.9% vs. 85.6%, 85.6% and 64.2% during the same time interval, respectively (P = 0.054). Cox regression analysis identified Hangzhou criteria (within vs. outside, hazard ratio (HR) 0.376) and diameter of the largest tumor (HR 3.523) to be independent predictors for overall survival. The only predictor for tumor-free survival was diameter of the largest tumor (HR 22.289).

CONCLUSIONS

Hangzhou criteria safely expanded the candidate pool and are feasible in assessment of candidates for SLT. This is helpful in donor liver allocation in transplant practice.

摘要

背景

挽救性肝移植(SLT)最近被提议用于肝切除术后复发性肝细胞癌;然而,SLT 中候选者评估标准尚未得到充分评估。

方法与结果

我们回顾性分析了 2004 年至 2012 年期间在浙江大学第一附属医院肝移植中心接受 SLT 的 53 例受者的结局及影响生存的因素。30 例受者符合杭州标准,其中 16 例也符合米兰标准,其余 23 例超出这两个标准。与超出标准的患者相比,符合米兰或杭州标准的患者 1 年、3 年和 5 年总生存率及无瘤生存率均更高。对于超出米兰标准但符合杭州标准的受者,其 1 年、3 年总生存率分别为 70.1%、70.1%,与符合米兰标准的受者相似,1 年、3 年和 5 年总生存率分别为 93.8%、62.1%和 62.1%(P = 0.586)。这两个亚组的无瘤生存率也相似,在相同时间间隔内分别为 51.9%、51.9%和 85.6%、85.6%、64.2%(P = 0.054)。Cox 回归分析确定杭州标准(符合与不符合,风险比(HR)0.376)和最大肿瘤直径(HR 3.523)是总生存的独立预测因素。无瘤生存的唯一预测因素是最大肿瘤直径(HR 2二十二点二八九)。

结论

杭州标准安全地扩大了候选者范围,在 SLT 候选者评估中是可行的。这有助于移植实践中的供肝分配。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/722d/3903638/2b69ae348a67/pone.0087222.g001.jpg

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