Jiang Li, Liao Anque, Wen Tianfu, Yan Lunan, Li Bo, Yang Jiayin
Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Transpl Int. 2014 Jun;27(6):562-9. doi: 10.1111/tri.12297. Epub 2014 Apr 2.
The optimum primary treatment strategy for early hepatocellular carcinoma (HCC) patients with multiple nodules remains unclear. We aimed to compare the outcomes of living donor liver transplantation (LDLT) with that of liver resection (LR) for early Child-Pugh A HCC patients with multiple nodules meeting the Milan criteria. From January 2007 to July 2012, 67 of 375 patients with early HCC in our centre fulfilled the inclusion criteria (group LDLT, n = 34 versus group LR, n = 33). Patient and tumour characteristics, operative data, postoperative course and outcomes were analysed retrospectively. The postoperative mortality and rate of major complications were similar in both groups. The 5-year overall survival (OS; 76.5% vs. 51.2%, P = 0.046) and recurrence-free survival (RFS; 72.0% vs. 19.8%, P = 0.000) were better in group LDLT than that in group LR. The 5-year OS and RFS were similar between patients with tumours located in the same lobe (TSL) and those in the different lobes (TDL) after LDLT, whereas the 5-year RFS was better in patients with tumours in TSL (30.6% vs. 0%, P = 0.012) after LR. In conclusion, primary LDLT might be the optimum treatment for early HCC patients with multiple nodules meeting the Milan criteria.
对于早期肝细胞癌（HCC）合并多个结节的患者，最佳的初始治疗策略仍不明确。我们旨在比较活体肝移植（LDLT）与肝切除术（LR）对符合米兰标准的早期Child-Pugh A级HCC合并多个结节患者的治疗效果。2007年1月至2012年7月，我们中心375例早期HCC患者中有67例符合纳入标准（LDLT组，n = 34；LR组，n = 33）。对患者和肿瘤特征、手术数据、术后病程及结局进行回顾性分析。两组术后死亡率和主要并发症发生率相似。LDLT组的5年总生存率（OS；76.5%对51.2%，P = 0.046）和无复发生存率（RFS；72.0%对19.8%，P = 0.000）均优于LR组。LDLT术后，肿瘤位于同一肝叶（TSL）的患者与肿瘤位于不同肝叶（TDL）的患者5年OS和RFS相似，而LR术后TSL患者的5年RFS更好（30.6%对0%，P = 0.012）。总之，对于符合米兰标准的早期HCC合并多个结节的患者，初次LDLT可能是最佳治疗方法。
