Wang Pusen, Li Hao, Shi Baojie, Que Weitao, Wang Chunguang, Fan Junwei, Peng Zhihai, Zhong Lin
Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 200080, Shanghai, China.
Oncotarget. 2016 Jun 7;7(23):35071-83. doi: 10.18632/oncotarget.9040.
Although salvage liver transplantation (LT) has been widely adopted as a treatment for recurrent hepatocellular carcinoma(HCC), candidate selection criteria have not been established. This single-center study aimed to identify risk factors associated with HCC recurrence and survival following salvage LT. The study included 74 patients treated with salvage LT between October 2001 and February 2013. The median follow-up was 37.2 months after LT. There were 29 cases of HCC recurrence and 31 deaths following LT. Microvascular invasion at the time of liver resection, a time interval to post-LR HCC recurrence of ≤ 12months, an alpha-fetoprotein level at LT greater than 200 ng/mL, and having undergone LT outside of the UCSF criteria were independent risk factors for HCC recurrence after salvage LT. Patients with no more than one risk factor had a 5-year recurrence-free survival rate of 71.2% compared to 15.9% in patients with two or more risk factors. These findings suggest that to avoid post-LT HCC recurrence and a dismal prognosis, patients with no more than one risk factor for recurrence should be given priority for salvage LT. These criteria may improve the outcomes of patients treated with salvage LT and facilitate the effective use of limited organ supplies.
尽管挽救性肝移植（LT）已被广泛用作复发性肝细胞癌（HCC）的一种治疗方法，但尚未确立候选者选择标准。这项单中心研究旨在确定挽救性肝移植后与HCC复发和生存相关的危险因素。该研究纳入了2001年10月至2013年2月期间接受挽救性肝移植治疗的74例患者。肝移植后的中位随访时间为37.2个月。肝移植后有29例HCC复发，31例死亡。肝切除时的微血管侵犯、肝切除术后至HCC复发的时间间隔≤12个月、肝移植时甲胎蛋白水平大于200 ng/mL以及在不符合加州大学旧金山分校标准的情况下接受肝移植是挽救性肝移植后HCC复发的独立危险因素。复发危险因素不超过一项的患者5年无复发生存率为71.2%，而有两项或更多危险因素的患者为15.9%。这些发现表明，为避免肝移植后HCC复发和不良预后，复发危险因素不超过一项的患者应优先接受挽救性肝移植。这些标准可能会改善接受挽救性肝移植患者的预后，并有助于有效利用有限的器官供应。
