Senkerikova R, Frankova S, Sperl J, Oliverius M, Kieslichova E, Filipova H, Kautznerova D, Honsova E, Trunecka P, Spicak J
Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Transplant Proc. 2014 Jun;46(5):1426-9. doi: 10.1016/j.transproceed.2014.03.010.
Orthotopic liver transplantation (OLT) currently represents the treatment of choice for early hepatocellular carcinoma (HCC). Preoperatively known HCC (pkHCC) is diagnosed via imaging methods before OLT or before HCC is found postoperatively in the liver explant, denoted as incidental HCC (iHCC). The aim of this study was a comprehensive analysis of the post-transplantation survival of patients with iHCC and the identification of risk factors of iHCC occurrence in cirrhotic liver.
We retrospectively reviewed 33 adult cirrhotic patients with incidentally found HCC, comparing them with 606 tumor-free adult cirrhotic patients with end-stage liver disease (group Ci) who underwent OLT in our center from January 1995 to August 2012. Within the same period, a total of 84 patients underwent transplantation for pkHCC. We compared post-transplantation survivals of iHCC, Ci, and pkHCC patients. In the group of cirrhotic patients (Ci + iHCC), we searched for risk factors of iHCC occurrence.
There was no difference in sex, Model for End-Stage Liver Disease score, and time spent on the waiting list in either group. In the multivariate analysis we identified age >57 years (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.75-8.14; P < .001), hepatitis C virus or alcoholic liver disease (OR, 3.89; 95% CI, 1.42-10.7; P < .001), and alpha-fetoprotein level >6.4 μg/L (OR, 6.65; 95% CI, 2.82-15.7; P = .002) to be independent predictors of iHCC occurrence. Both the 1-, 3-, and 5-year overall survival (OS) and the 1-, 3- and 5-year recurrence-free survival (RFS) differed in iHCC patients compared with the Ci group (iHCC: OS 79%, 72%, and 68%, respectively; RFS 79%, 72%, and 63%, respectively; vs Ci: OS = RFS: 93%, 94%, and 87%, respectively; P < .001).
The survival of iHCC patients is worse than in tumor-free cirrhotic patients, but similar to pkHCC patients. The independent risk factors for iHCC occurrence in cirrhotic liver are age, hepatitis C virus, or alcoholic liver disease etiology of liver cirrhosis and alpha-fetoprotein level.
原位肝移植（OLT）目前是早期肝细胞癌（HCC）的首选治疗方法。术前已知的HCC（pkHCC）通过成像方法在OLT前或术后在肝移植肝中发现HCC之前被诊断出来，称为偶然发现的HCC（iHCC）。本研究的目的是全面分析iHCC患者的移植后生存率，并确定肝硬化肝脏中iHCC发生的危险因素。
我们回顾性分析了33例偶然发现HCC的成年肝硬化患者，并将他们与1995年1月至2012年8月在我们中心接受OLT的606例无肿瘤的晚期肝病成年肝硬化患者（Ci组）进行比较。在同一时期，共有84例患者因pkHCC接受移植。我们比较了iHCC、Ci和pkHCC患者的移植后生存率。在肝硬化患者组（Ci+iHCC）中，我们寻找iHCC发生的危险因素。
两组患者在性别、终末期肝病模型评分和等待名单上的时间方面均无差异。在多变量分析中，我们确定年龄>57岁（比值比[OR]，3.37；95%置信区间[CI]，1.75-8.14；P<.001）、丙型肝炎病毒或酒精性肝病（OR，3.89；95%CI，1.42-10.7；P<.001）以及甲胎蛋白水平>6.4μg/L（OR，6.65；95%CI，2.82-15.7；P=.002）是iHCC发生的独立预测因素。与Ci组相比，iHCC患者的1年、3年和5年总生存率（OS）以及无复发生存率（RFS）均有所不同（iHCC：OS分别为79%、72%和68%；RFS分别为79%、72%和63%；vs Ci：OS=RFS：分别为93%、94%和87%；P<.001）。
iHCC患者的生存率低于无肿瘤的肝硬化患者，但与pkHCC患者相似。肝硬化肝脏中iHCC发生的独立危险因素是年龄、丙型肝炎病毒或酒精性肝病病因以及甲胎蛋白水平。
