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肝移植时的时间作为肝移植后肝细胞癌复发的预测指标。

Time to transplantation as a predictor of hepatocellular carcinoma recurrence after liver transplantation.

作者信息

Samoylova Mariya L, Dodge Jennifer L, Yao Francis Y, Roberts John Paul

机构信息

Departments of Surgery (Division of Transplant Surgery), University of California San Francisco, San Francisco, CA.

出版信息

Liver Transpl. 2014 Aug;20(8):937-44. doi: 10.1002/lt.23902. Epub 2014 Jul 3.

DOI:10.1002/lt.23902
PMID:24797145
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4394747/
Abstract

In the United States, there are significant geographic disparities in the time to transplantation for patients with hepatocellular carcinoma (HCC); it is possible that rapid transplantation contributes to higher rates of posttransplant HCC recurrence because there is insufficient time for the tumor biology to manifest. In this study, we compared HCC recurrence in rapid transplant patients and their slower transplant counterparts. We identified adult liver transplantation (LT) candidates in the Organ Procurement and Transplantation Network/United Network for Organ Sharing (UNOS) data set who were granted an initial exception for an HCC diagnosis between January 1, 2006 and September 30, 2010 and underwent transplantation in the same time window. Patients were followed until HCC recurrence, non-HCC-related death, or last follow-up. The cumulative incidence of HCC recurrence was compared for patients waiting ≤ 120 days and patients waiting >120 days from an HCC exception to LT. The association between the risk of posttransplant recurrence and the wait time was further evaluated via competing risks regression with the Fine and Gray model. For 5002 LT recipients with HCC, the median wait time from an exception to LT was 77 days, and it varied from 30 to 169 days by UNOS region. The cumulative incidence of posttransplant HCC recurrence was 3.3% [95% confidence interval (CI) = 2.8%-3.8%] and 5.6% (95% CI = 5.0%-6.3%) within 1 and 2 years, respectively. The rate of observed recurrence within 1 year of transplantation was significantly lower for patients waiting >120 days versus patients waiting ≤ 120 days (2.2% versus 3.9%, P = 0.002); however, the difference did not persist at 2 years (5.0% versus 5.9%, P = 0.09). After we accounted for clinical factors, the HCC recurrence risk was reduced by 40% for patients waiting >120 days (subhazard ratio = 0.6, P = 0.005). In conclusion, the risk of HCC recurrence within the first year after transplantation may be lessened by the institution of a mandatory waiting time after an exception is granted.

摘要

在美国,肝细胞癌(HCC)患者接受移植的时间存在显著的地域差异;快速移植可能导致移植后HCC复发率较高,因为肿瘤生物学特性没有足够时间显现出来。在本研究中,我们比较了快速移植患者和移植较慢患者的HCC复发情况。我们在器官获取与移植网络/器官共享联合网络(UNOS)数据集中确定了成年肝移植(LT)候选人,这些人在2006年1月1日至2010年9月30日期间因HCC诊断获得了初始豁免,并在同一时间窗口内接受了移植。对患者进行随访,直至HCC复发、非HCC相关死亡或最后一次随访。比较了从HCC豁免到LT等待≤120天的患者和等待>120天的患者HCC复发的累积发生率。通过使用Fine和Gray模型的竞争风险回归进一步评估移植后复发风险与等待时间之间的关联。对于5002例接受LT的HCC患者,从豁免到LT的中位等待时间为77天,按UNOS地区不同,从30天到169天不等。移植后1年和2年内HCC复发的累积发生率分别为3.3%[95%置信区间(CI)=2.8%-3.8%]和5.6%(95%CI=5.0%-6.3%)。移植后1年内,等待>120天的患者观察到的复发率显著低于等待≤120天的患者(2.2%对3.9%,P=0.002);然而,2年时差异不再存在(5.0%对5.9%,P=0.09)。在我们考虑了临床因素后,等待>120天的患者HCC复发风险降低了40%(亚风险比=0.6,P=0.005)。总之,在获得豁免后设定强制等待时间,可能会降低移植后第一年HCC复发的风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3c4/4394747/2efa166fef2a/nihms677863f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3c4/4394747/6252a675181e/nihms677863f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3c4/4394747/dfc853cbceb9/nihms677863f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3c4/4394747/2efa166fef2a/nihms677863f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3c4/4394747/6252a675181e/nihms677863f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3c4/4394747/dfc853cbceb9/nihms677863f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3c4/4394747/2efa166fef2a/nihms677863f3.jpg

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本文引用的文献

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Liver Transpl. 2013 Dec;19(12):1343-53. doi: 10.1002/lt.23753.
2
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Liver Transpl. 2013 Dec;19(12):1318-23. doi: 10.1002/lt.23735. Epub 2013 Oct 21.
3
Moving past "One size (and number) fits all" in the selection of candidates with hepatocellular carcinoma for liver transplantation.在选择肝细胞癌患者进行肝移植时,摒弃“一刀切(和单一数字标准)”的做法。
Liver Transpl. 2013 Oct;19(10):1055-8. doi: 10.1002/lt.23730.
4
Alpha-fetoprotein and modified response evaluation criteria in solid tumors progression after locoregional therapy as predictors of hepatocellular cancer recurrence and death after transplantation.局部治疗后甲胎蛋白和改良实体瘤反应评估标准在预测移植后肝癌复发和死亡中的作用。
Liver Transpl. 2013 Oct;19(10):1108-18. doi: 10.1002/lt.23706.
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Liver transplantation in the MELD era--analysis of the OPTN/UNOS registry.终末期肝病模型(MELD)时代的肝移植——器官获取与移植网络(OPTN)/美国器官共享联合网络(UNOS)登记处分析
Clin Transpl. 2012:41-65.
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Living vs. deceased donor liver transplantation for hepatocellular carcinoma: a systematic review and meta-analysis.活体与死体供肝移植治疗肝细胞癌:系统评价和荟萃分析。
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Recurrence of hepatocellular cancer after liver transplantation: the role of primary resection and salvage transplantation in East and West.肝移植后肝细胞癌复发:东西方原发切除术和挽救性移植的作用。
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Increasing disparity in waitlist mortality rates with increased model for end-stage liver disease scores for candidates with hepatocellular carcinoma versus candidates without hepatocellular carcinoma.肝癌患者与非肝癌患者的终末期肝病模型评分增加导致等待名单死亡率差异增大。
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