伴有胆管癌栓的肝细胞癌肝移植长期生存分析

Long-term survival analysis of liver transplantation for hepatocellular carcinoma with bile duct tumor thrombus.

作者信息

Ha T-Y, Hwang S, Moon D-B, Ahn C-S, Kim K-H, Song G-W, Jung D-H, Park G-C, Park H-W, Park Y-H, Kang S-H, Jung B-H, Lee S-G

机构信息

Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

出版信息

Transplant Proc. 2014 Apr;46(3):774-7. doi: 10.1016/j.transproceed.2013.10.053.

DOI:10.1016/j.transproceed.2013.10.053

PMID:24767346

Abstract

BACKGROUND

Long-term prognosis of liver transplantation (LT) for hepatocellular carcinoma (HCC) with macroscopic bile duct tumor thrombus (BDTT) has not been well assessed. This study intended to analyze the post-transplantation outcomes in patients who had HCC with macroscopic BDTT.

METHODS

A retrospective study was performed with 14 patients who underwent LT for HCC with BDTT (0.7%) after selection from an institutional database of 2052 adult LT cases.

RESULTS

Types of LT were living donor LT in 13 and deceased donor LT in 1. The extents of BDTT were Ueda type 1 in 4, type 2 in 3, and type 3 in 7. Milan criteria were met in 8 (57.1%). Concurrent bile duct resection was performed in 7 (50%). Mean model for end-stage liver disease score was 18.7 ± 4.9. Mean graft-recipient weight ratio was 1.2 ± 0.3. There was one case of perioperative mortality and one case of HCC-unrelated late mortality. Cumulative HCC recurrence rates were 15.4% at 1 year, 46.2% at 3 years, and 46.2% at 5 years. Overall patient survival rates were 92.9% at 1 year, 57.1% at 3 years, and 50% at 5 years. Univariate risk factor analyses revealed that only macrovascular invasion was a significant risk factor for HCC recurrence (P = .019).

CONCLUSIONS

The results of this study revealed that LT for HCC with macroscopic BDTT has a high risk of post-transplantation HCC recurrence; therefore, further large-volume studies are necessary to elucidate the risk factors.

摘要

背景

肝细胞癌（HCC）合并肉眼可见胆管肿瘤血栓（BDTT）患者接受肝移植（LT）后的长期预后尚未得到充分评估。本研究旨在分析HCC合并肉眼可见BDTT患者的移植后结局。

方法

从2052例成人LT病例的机构数据库中选取14例因HCC合并BDTT接受LT的患者进行回顾性研究。

结果

LT类型为活体供肝LT 13例，尸体供肝LT 1例。BDTT范围为上田1型4例，2型3例，3型7例。8例（57.1%）符合米兰标准。7例（50%）同时进行了胆管切除术。终末期肝病评分平均为18.7±4.9。移植物与受者体重比平均为1.2±0.3。围手术期死亡1例，与HCC无关的晚期死亡1例。1年、3年和5年的累积HCC复发率分别为15.4%、46.2%和46.2%。患者1年、3年和5年的总生存率分别为92.9%、57.1%和50%。单因素风险因素分析显示，仅大血管侵犯是HCC复发的显著风险因素（P = .019）。