Kamel Refaat, Hatata Yaser, Hosny Karim, Nabil Ahmed, El-Deen Abd-Allah Alaa, Mostafa Aaser, Abdel-Aal Amr, Elganzoury Mahmoud Z, Elmalt Osama, Marwan Ibrahim, Hosny Adel
Department of Surgery, Ein Shams University, Cairo, Egypt.
Exp Clin Transplant. 2017 Mar;15(Suppl 2):12-20. doi: 10.6002/ect.TOND16.L5.
Liver transplant performed for hepatocellular carcinoma must adhere to criteria for the size and number of focal hepatic lesions to lower the incidence of recurrence and achieve survival rates comparable to patients transplanted for other indications. Since the Milan criteria were established in 1996, there have been many less restrictive criteria yielding similar results. Our aim was to identify the prognostic factors for patient survival and for recurrence of hepatocellular carcinoma for patients within and beyond the Milan criteria.
This retrospective and prospective analysis was conducted in 60 adult patients who underwent right lobe living-donor liver transplant for cirrhosis complicated by hepatocellular carcinoma at Dar Al Fouad Hospital, 6th of October City, Egypt, between August 2001 and June 2012. The median follow-up was 39.5 months.
Overall 1-, 3-, and 5-year survival rates were 98.3%, 93.5%, and 71.4%. Overall disease-free survival rates at 1, 3, and 5 years were 96.6%, 93.5%, and 64.2%. There was no statistically significant difference in overall survival time between patients within and beyond the Milan criteria. Factors affecting recurrence were the tumor grade, lobar distribution, size of the largest nodule, and the total tumor burden in the explanted liver. Recurrence adversely affected survival.
Using our criteria of a single tumor ≤ 6 cm, or 2 to 3 tumors with the largest ≤ 4.5 cm, or 4 to 5 tumors with the largest ≤ 3 cm and total tumor size ≤ 8 cm resulted in overall survival comparable to patients within the Milan criteria.
为肝细胞癌进行的肝移植必须遵循肝局灶性病变大小和数量的标准，以降低复发率，并实现与因其他适应症接受移植的患者相当的生存率。自1996年米兰标准确立以来，出现了许多限制较少但结果相似的标准。我们的目的是确定米兰标准以内和以外患者的生存预后因素以及肝细胞癌复发的预后因素。
对2001年8月至2012年6月期间在埃及十月六日城达勒富阿德医院因肝硬化合并肝细胞癌接受右半肝活体肝移植的60例成年患者进行了回顾性和前瞻性分析。中位随访时间为39.5个月。
总体1年、3年和5年生存率分别为98.3%、93.5%和71.4%。1年、3年和5年的总体无病生存率分别为96.6%、93.5%和64.2%。米兰标准以内和以外的患者总体生存时间无统计学显著差异。影响复发的因素包括肿瘤分级、叶分布、最大结节大小以及切除肝脏中的总肿瘤负荷。复发对生存有不利影响。
采用我们的标准，即单个肿瘤≤6 cm，或2至3个肿瘤且最大肿瘤≤4.5 cm，或4至5个肿瘤且最大肿瘤≤3 cm且总肿瘤大小≤8 cm，总体生存率与米兰标准以内的患者相当。
