Shah Najmul Hassan, Dar Faisal Saud, Bhatti Abu Bakar Hafeez, Rana Atif, Salih Mohammad
Department of Gastroenterology and Hepatology, Shifa International Hospital, Islamabad, Pakistan.
Department of HPB Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan.
Ann Transplant. 2016 Oct 28;21:668-674. doi: 10.12659/aot.899715.
BACKGROUND The Barcelona clinic liver cancer (BCLC) staging system is considered the standard of care for hepatocellular carcinoma (HCC) management. It has various limitations, including lack of second-line treatment options and combination therapy. We prospectively collected data on our HCC patients based on a new decision-making tool (NDT). The objective of this study was to determine the applicability of this tool and compare it with BCLC for treatment allocation, in particular with respect to liver transplantation. MATERIAL AND METHODS We retrospectively reviewed HCC patients who were managed based on an NDT that was developed in 2012. All patients whose treatment decision was based on this tool between 2012 and 2015 were included. Comparison was made with BCLC. Survival was compared for patients who underwent liver transplantation. RESULTS Based on the NDT, 406 (40.6%) patients were eligible for curative treatment versus only 22 (2.2%) patients based on BCLC. A total of 58 (5.8%) patients underwent liver transplant based on the NDT, while only 2 (0.2%) were transplantable based on BCLC. Estimated 3-year survival for transplanted patients based on the NDT was 73%. There were 41 (4.1%) stage C and 15 (1.5%) stage D BCLC patients who received transplant based on the NDT. Estimated 3-year survival for stage A, C, and D BCLC patients who received transplantation was 100%,72%, and 67%, respectively (P=0.6). CONCLUSIONS The NDT correctly identified a group of HCC patients for liver transplantation who would otherwise have received palliative treatment based on the BCLC algorithm.
背景 巴塞罗那临床肝癌（BCLC）分期系统被认为是肝细胞癌（HCC）管理的治疗标准。它有各种局限性，包括缺乏二线治疗方案和联合治疗。我们基于一种新的决策工具（NDT）前瞻性地收集了我们HCC患者的数据。本研究的目的是确定该工具的适用性，并将其与BCLC在治疗分配方面进行比较，特别是在肝移植方面。材料与方法 我们回顾性分析了基于2012年开发的NDT进行管理的HCC患者。纳入了2012年至2015年间治疗决策基于该工具的所有患者。与BCLC进行比较。对接受肝移植的患者的生存率进行了比较。结果 基于NDT，406例（40.6%）患者符合根治性治疗条件，而基于BCLC只有22例（2.2%）患者符合。共有58例（5.8%）患者基于NDT接受了肝移植，而基于BCLC只有2例（0.2%）可进行移植。基于NDT的移植患者估计3年生存率为73%。有41例（4.1%）BCLC C期和15例（1.5%）D期患者基于NDT接受了移植。接受移植的BCLC A、C和D期患者的估计3年生存率分别为100%、72%和67%（P = 0.6）。结论 NDT正确识别了一组原本会根据BCLC算法接受姑息治疗的HCC肝移植患者。
