Lee Kwang-Woong, Suh Suk-Won, Choi YoungRok, Jeong Jaehong, Yi Nam-Joon, Kim Hyeyoung, Yoon Kyung Chul, Hong Suk Kyun, Kim Hyo-Sin, Lee Kyung-Bun, Suh Kyung-Suk
Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea.
Liver Transpl. 2017 Jan;23(1):19-27. doi: 10.1002/lt.24610. Epub 2016 Dec 5.
The indication of liver transplantation (LT) for the treatment of advanced hepatocellular carcinoma (HCC) is expanding. However, portal vein tumor thrombus (PVTT) has been still accepted as an absolute contraindication. We experienced an unexpectedly good prognosis in selected patients. Therefore, we tried to identify the prognostic factors after LT for HCC with major PVTT. Among 282 patients who underwent living donor liver transplantation (LDLT) for HCC from January 2009 to December 2013, 11 (3.9%) patients with major PVTT that was preoperatively diagnosed were investigated. The 1-, 3-, and 5-year recurrence-free survival rates were 63.6%, 45.5%, and 45.5%, respectively, and all recurrent cases showed intrahepatic and extrahepatic recurrence. The 1-, 3-, and 5-year overall survival rates were 72.7%, 63.6%, and 63.6%, respectively, and 2 patients with delayed recurrence survived approximately 5 years after LT. Main portal vein (PV) invasion (P < 0.01), high alpha-fetoprotein × protein induced by vitamin K absence/antagonist-II (AP) score (≥20,000; P < 0.01), high standardized uptake value (SUV) ratio (tumor/background liver) in positron emission tomography (≥2.1; P < 0.01), and a large original tumor (≥7 cm; P = 0.03) were significant risk factors for recurrence. In conclusion, if the PVTT has not expanded to the main PV and the AP score is not high, we can consider LDLT as a curative treatment option. Liver Transplantation 23:19-27 2017 AASLD.
肝移植（LT）用于治疗晚期肝细胞癌（HCC）的适应证正在不断扩大。然而，门静脉肿瘤血栓（PVTT）仍被视为绝对禁忌证。我们在部分患者中观察到了出乎意料的良好预后。因此，我们试图确定LT治疗伴有主要PVTT的HCC后的预后因素。在2009年1月至2013年12月期间接受活体肝移植（LDLT）治疗HCC的282例患者中，对术前诊断为主要PVTT的11例（3.9%）患者进行了研究。1年、3年和5年无复发生存率分别为63.6%、45.5%和45.5%，所有复发病例均表现为肝内和肝外复发。1年、3年和5年总生存率分别为72.7%、63.6%和63.6%，2例延迟复发患者在LT后存活了约5年。主要门静脉（PV）侵犯（P＜0.01）、高甲胎蛋白×维生素K缺乏/拮抗剂-II诱导蛋白（AP）评分（≥20,000；P＜0.01）、正电子发射断层扫描中高标准化摄取值（SUV）比值（肿瘤/肝背景）（≥2.1；P＜0.01）以及较大的原发肿瘤（≥7 cm；P = 0.03）是复发的显著危险因素。总之，如果PVTT未扩展至主要PV且AP评分不高，我们可以将LDLT视为一种治愈性治疗选择。《肝脏移植》2017年第23卷：19 - 27页，美国肝病研究学会
