Palmer William C, Lee David, Burns Justin, Croome Kristopher, Rosser Barry, Patel Tushar, Keaveny Andrew P, Pungpapong Surakit, Satyanarayana Raj, Yataco Maria, Nakhleh Raouf, Musto Kaitlyn R, Canabal Alexandra M, Turnage Alex K, Hodge David O, Nguyen Justin H, Harnois Denise M
Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA.
Department of Pathology, Mayo Clinic, Jacksonville, Florida, USA.
Ann Hepatol. 2017 May-Jun;16(3):402-411. doi: 10.5604/16652681.1235483.
Liver transplantation (LT) provides durable survival for hepatocellular carcinoma (HCC). However, there is continuing debate concerning the impact of wait time and acceptable tumor burden on outcomes after LT. We sought to review outcomes of LT for HCC at a single, large U.S. center, examining the influence of wait time on post-LT outcomes.
We reviewed LT for HCC at Mayo Clinic in Florida from 1/1/2003 until 6/30/2014. Follow up was updated through 8/1/ 2015.
From 2003-2014, 978 patients were referred for management of HCC. 376 patients were transplanted for presumed HCC within Milan criteria, and the results of these 376 cases were analyzed. The median diagnosis to LT time was 183 days (8 - 4,337), and median transplant list wait time was 62 days (0 - 1815). There was no statistical difference in recurrence-free or overall survival for those with wait time of less than or greater than 180 days from diagnosis of HCC to LT. The most important predictor of long term survival after LT was HCC recurrence (HR: 18.61, p < 0.001). Recurrences of HCC as well as survival were predicted by factors related to tumor biology, including histopathological grade, vascular invasion, and pre-LT serum alpha-fetoprotein levels. Disease recurrence occurred in 13%. The overall 5-year patient survival was 65.8%, while the probability of 5-year recurrence-free survival was 62.2%.
In this large, single-center experience with long-term data, factors of tumor biology, but not a longer wait time, were associated with recurrence-free and overall survival.
肝移植（LT）为肝细胞癌（HCC）患者提供了持久的生存机会。然而，关于等待时间和可接受的肿瘤负荷对肝移植术后结局的影响，仍存在持续的争论。我们试图回顾美国一家大型中心肝移植治疗HCC的结局，探讨等待时间对肝移植术后结局的影响。
我们回顾了2003年1月1日至2014年6月30日佛罗里达州梅奥诊所肝移植治疗HCC的情况。随访更新至2015年8月1日。
2003年至2014年，978例患者因HCC接受治疗。376例患者因符合米兰标准的疑似HCC接受了移植，并对这376例病例的结果进行了分析。从诊断到肝移植的中位时间为183天（8 - 4337天），移植等待名单上的中位等待时间为62天（0 - 1815天）。从HCC诊断到肝移植等待时间少于或多于180天的患者，其无复发生存率或总生存率无统计学差异。肝移植术后长期生存的最重要预测因素是HCC复发（HR：18.61，p < 0.001）。HCC复发以及生存率可通过与肿瘤生物学相关的因素预测，包括组织病理学分级、血管侵犯和肝移植前血清甲胎蛋白水平。疾病复发率为13%。患者总体5年生存率为65.8%，而5年无复发生存率为62.2%。
在这项拥有长期数据的大型单中心研究中，与无复发生存率和总生存率相关的是肿瘤生物学因素，而非更长的等待时间。
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