Zhang H-M, Jiang W-T, Pan C, Deng Y-L, Zheng H, Shen Z-Y
Transplantation Department, First Central Clinical College of Tianjin Medical University, Tianjin First Central Hospital, Tianjin Key Laboratory of Organ Transplantation, Tianjin, People's Republic of China.
Transplantation Department, First Central Clinical College of Tianjin Medical University, Tianjin First Central Hospital, Tianjin Key Laboratory of Organ Transplantation, Tianjin, People's Republic of China.
Transplant Proc. 2015 Mar;47(2):438-44. doi: 10.1016/j.transproceed.2014.10.046.
The selection criteria for salvage liver transplantation (SLT) candidates have not been previously established. A global analysis for the association between the criteria and prognosis is required. All of the adult patients who underwent liver transplantation with a diagnosis of hepatocellular carcinoma (HCC) from January 1, 2000, to December 31, 2011, were retrospectively analyzed. A total of 1,554 cases were involved, including 1,392 primary liver transplantation (PLT) and 162 SLT cases. All the cases were classified into 3 groups according to the Milan criteria combined with the University of California, San Francisco (UCSF), criteria, and significant differences were found between the 2 groups. The overall graft survival rate was lower in all cases of SLT than in PLT (P = .030). Within the Milan criteria, no significant difference in the graft survival rate was found between PLT and SLT. In a Cox regression analysis, the Model for End-Stage Liver Disease (MELD) score and tumor levels graded according to the Milan/UCSF criteria were found to be independent risk factors for the graft survival rate. Receiver operating characteristic (ROC) curves were generated by the fatality risk values calculated by means of the Cox model and the 1-year graft survival rates of all the patients and of the SLT patients. The areas under the ROC curves were 0.922 and 0.935, respectively. Compared with PLT, the global graft survival rate of SLT was compromised. The MELD score and Milan/UCSF criteria were effective in predicting the prognosis of PLT and SLT. Therefore, when the recurrent lesions of HCC are within the Milan criteria, SLT can be performed with a good prognosis.
挽救性肝移植（SLT）候选者的选择标准此前尚未确立。需要对这些标准与预后之间的关联进行全面分析。对2000年1月1日至2011年12月31日期间接受肝移植且诊断为肝细胞癌（HCC）的所有成年患者进行了回顾性分析。共纳入1554例病例，包括1392例初次肝移植（PLT）和162例SLT病例。所有病例根据米兰标准联合加利福尼亚大学旧金山分校（UCSF）标准分为3组，两组之间存在显著差异。所有SLT病例的总体移植物存活率低于PLT（P = 0.030）。在米兰标准范围内，PLT和SLT的移植物存活率无显著差异。在Cox回归分析中，终末期肝病模型（MELD）评分和根据米兰/UCSF标准分级的肿瘤水平被发现是移植物存活率的独立危险因素。通过Cox模型计算的死亡风险值以及所有患者和SLT患者的1年移植物存活率生成了受试者操作特征（ROC）曲线。ROC曲线下面积分别为0.922和0.935。与PLT相比，SLT的总体移植物存活率受到影响。MELD评分和米兰/UCSF标准在预测PLT和SLT的预后方面有效。因此，当HCC复发灶在米兰标准范围内时，可进行SLT且预后良好。
