Lee Christopher, Kim Andrew, Santos Idoia, Cen Yong, Alexopoulos Sophoclis, Navarro Shannon, Wallman Melissa, Dhanireddy Kiran, Grant Edward
Department of Radiology, Keck School of Medicine of USC, Los Angeles, CA, USA.
Clin Transplant. 2014 Dec;28(12):1402-9. doi: 10.1111/ctr.12471. Epub 2014 Nov 6.
No guidelines exist for the management of cardiophrenic lymph nodes in patients with hepatocellular carcinoma (HCC) being evaluated for liver transplantation.
One hundred and seventy-eight patients with HCC listed for liver transplant received both pre-transplant computed tomography (CT) and follow-up CT scans. Enlarged cardiophrenic lymph nodes on CT were characterized and followed on subsequent scans; lymph node outcomes were assigned to "reduced" and "not reduced" categories. Tumor and patient characteristics were also recorded.
Seventy-one of one hundred and seventy-eight patients (39.9%) had at least one cardiophrenic lymph node larger than 8 mm in diameter on pre-transplant CT. One hundred and sixty-six total lymph nodes were characterized. Six lymph nodes (3.6%) in two patients increased in size on follow-up imaging; all six cardiophrenic lymph nodes were presumed to represent metastases. There was a statistically significant reduction in lymph node size in patients who were transplanted vs. those who were not transplanted. Furthermore, a statistically significant association was found between increasing Model for End-Stage Liver Disease score and lymph node size reduction. There were no significant differences in post-transplant survival between patients with different lymph node outcomes.
In the absence of metastatic disease in other sites, these lymph nodes are probably reactive; further workup is likely not necessary.
对于接受肝移植评估的肝细胞癌（HCC）患者，目前尚无关于心膈淋巴结管理的指南。
178例等待肝移植的HCC患者接受了移植前计算机断层扫描（CT）及随访CT扫描。对CT上增大的心膈淋巴结进行特征描述，并在后续扫描中进行跟踪；淋巴结结局分为“缩小”和“未缩小”两类。同时记录肿瘤和患者特征。
178例患者中有71例（39.9%）在移植前CT上至少有一个直径大于8mm的心膈淋巴结。共对166个淋巴结进行了特征描述。两名患者的6个淋巴结（3.6%）在随访成像中增大；所有6个心膈淋巴结均被推测为转移灶。移植患者与未移植患者的淋巴结大小有统计学意义上的显著减小。此外，终末期肝病模型评分增加与淋巴结大小减小之间存在统计学意义上的显著关联。不同淋巴结结局的患者移植后生存率无显著差异。
在其他部位无转移性疾病的情况下，这些淋巴结可能是反应性的；可能无需进一步检查。
