Seshadri Ramanathan M, Besur Siddesh, Niemeyer David J, Templin Megan, McKillop Iain H, Swan Ryan Z, Martinie John B, Russo Mark W, Iannitti David A
Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
HPB (Oxford). 2014 Dec;16(12):1102-9. doi: 10.1111/hpb.12300. Epub 2014 Jun 25.
Liver transplantation (LT) is a treatment option in select patients with hepatocellular carcinoma (HCC). The aim of the present study was to compare survival in Stage I or II HCC patients undergoing either liver transplant (LT) or a liver resection (LR).
The study is a retrospective analysis of the National Cancer Data Base (1998-2011). In total, 148,882 patients with liver cancer were identified, of which 5-year survival data (1998-2006) were available for 64,227 patients. Patients were stratified by the American Joint Committee on Cancer (AJCC) clinical stage I and II. Kaplan-Meier curves and log-rank tests were used for statistical analysis.
3340 HCC patients met analysis criteria. Among stage I HCC, 860 had LT and 871 had LR. Among stage II HCC, 833 had LT and 776 LR. In stage I patients the median survival for LT and LR were 127.9 and 56.7 months, respectively, (P < 0.0001) and in stage II patients the median survival was 110.8 and 42.8 months (P < 0.0001). Unlike LT patients, LR patients with Stage I HCC had a longer median survival compared with Stage II patients (P = 0.0002).
Liver transplantation offers a survival advantage compared with a liver resection among patients with Stage I and II HCC. LT is the best surgical treatment for early stage (I/II) HCC in patients with advanced fibrosis or cirrhosis, whereas LR provides equivalent outcomes to LT in patients without advanced fibrosis and should be considered as the first surgical option.
肝移植（LT）是特定肝细胞癌（HCC）患者的一种治疗选择。本研究的目的是比较接受肝移植（LT）或肝切除术（LR）的I期或II期HCC患者的生存率。
本研究是对国家癌症数据库（1998 - 2011年）的回顾性分析。总共确定了148,882例肝癌患者，其中64,227例患者有5年生存数据（1998 - 2006年）。患者按美国癌症联合委员会（AJCC）临床I期和II期进行分层。采用Kaplan - Meier曲线和对数秩检验进行统计分析。
3340例HCC患者符合分析标准。在I期HCC患者中，860例行LT，871例行LR。在II期HCC患者中，833例行LT，776例行LR。I期患者中，LT和LR的中位生存期分别为127.9个月和56.7个月（P < 0.0001），II期患者中，中位生存期分别为110.8个月和42.8个月（P < 0.0001）。与LT患者不同，I期HCC的LR患者中位生存期比II期患者长（P = 0.0002）。
与肝切除术相比，肝移植在I期和II期HCC患者中具有生存优势。对于有晚期纤维化或肝硬化的患者，LT是早期（I/II）HCC的最佳手术治疗方法，而对于没有晚期纤维化的患者，LR与LT疗效相当，应被视为首选手术方式。
