Donat M, Alonso S, Pereira F, Ferrero E, Carrión L, Acin-Gándara D, Moreno E
Department of General and Visceral Surgery, Infanta Leonor Hospital, Madrid, Spain.
Department of General and Visceral Surgery, Fuenlabrada University Hospital, Madrid, Spain.
Transplant Proc. 2016 Jul-Aug;48(6):1968-77. doi: 10.1016/j.transproceed.2016.04.002.
The aim of this study was to identify predictors of overall survival (OS), disease-free survival (DFS), and recurrence in a cohort of 151 patients with hepatocellular carcinoma (HCC) and cirrhosis who were treated by liver transplantation (LT).
A retrospective database of patients undergoing LT for radiologically diagnosed HCC at "12 de Octubre" Hospital, Madrid during 1986-2006 was analyzed.
The median follow-up was 67.44 months (SD = 55.7 months). Overall 1-, 3-, 5-, and 10-year survival was 87.5%, 73.7%, 64.1% and 43.4%, respectively. The 5-year OS of patients beyond the Milan criteria was 47.14%, whereas that of patients within the Milan criteria was 70.13% (P = .011). The 5-year OS of patients beyond the Milan criteria and with microvascular invasion (MVI) was 27.27%, whereas that of patients beyond the Milan criteria and without MVI criteria was 57.89% (P = .003). Multivariate analysis of prognostic factors revealed MVI and G3 to be independent and statistically significant factors affecting OS (P < .0001 and P = .045, respectively), DFS (P < .0001 and P = .004, respectively), and recurrence (P = .0002 and P = .028, respectively). Multivariate analysis of prognostic factors also revealed preoperative fine-needle aspiration (FNA) to be an independent negative statistically significant factor affecting recurrence (P = .0022). Multivariate analysis of predictive MVI factors revealed preoperative α-fetoprotein (AFP) levels >200 ng/mL to be an independent positive and statistically significant predictor of MVI (P = .0004).
MVI and G3 are independent negative factors affecting OS, DFS, and recurrence. The presence of MVI or AFP levels >200 ng/mL represent a contraindication for LT, as long as the patient is beyond the Milan criteria.
本研究旨在确定151例接受肝移植（LT）治疗的肝细胞癌（HCC）合并肝硬化患者的总生存期（OS）、无病生存期（DFS）和复发的预测因素。
分析了1986年至2006年期间在马德里“10月12日”医院因放射学诊断为HCC而接受LT治疗的患者的回顾性数据库。
中位随访时间为67.44个月（标准差=55.7个月）。总体1年、3年、5年和10年生存率分别为87.5%、73.7%、64.1%和43.4%。超出米兰标准的患者5年总生存率为47.14%，而符合米兰标准的患者为70.13%（P=0.011）。超出米兰标准且有微血管侵犯（MVI）的患者5年总生存率为27.27%，而超出米兰标准且无MVI标准的患者为57.89%（P=0.003）。预后因素的多变量分析显示，MVI和G3是影响总生存期（P分别<0.0001和P=0.045）、无病生存期（P分别<0.0001和P=0.004）和复发（P分别=0.0002和P=0.028）的独立且具有统计学意义的因素。预后因素的多变量分析还显示，术前细针穿刺活检（FNA）是影响复发的独立负性统计学显著因素（P=0.0022）。预测MVI因素的多变量分析显示，术前甲胎蛋白（AFP）水平>200 ng/mL是MVI的独立阳性且具有统计学意义的预测指标（P=0.0004）。
MVI和G3是影响总生存期、无病生存期和复发的独立负性因素。只要患者超出米兰标准，MVI的存在或AFP水平>200 ng/mL均代表LT的禁忌证。
