Medical Imaging Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris-Université Paris-Est, Créteil, France.
Department of Radiology, Medical Imaging Center Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Hepatology. 2018 Jan;67(1):204-215. doi: 10.1002/hep.29468. Epub 2017 Nov 15.
The salvage liver transplantation (SLT) strategy was conceived for initially resectable and transplantable (R&T) hepatocellular carcinoma (HCC) patients, to try to obviate upfront liver transplantation, with the "safety net" of SLT in case of postresection recurrence. The SLT strategy is successful or curative when patients are recurrence free following primary resection alone, or after SLT for recurrence. The aim of the current study was to determine the SLT strategy's potential for cure in R&T HCC patients, and to identify predictors for its success. From 1994 to 2012, all R&T HCC patients with cirrhosis were enrolled in the SLT strategy. An intention-to-treat (ITT) analysis was used to determine this strategy's outcomes and predictors of success according to the above definition. In total, 110 patients were enrolled in the SLT strategy. Sixty-three patients (57%) had tumor recurrence after initial resection, and in 30 patients SLT could be performed (recurrence transplantability rate = 48%). From the time of initial resection, ITT 5-year overall and disease-free survival rates were 69% and 60%, respectively. The SLT strategy was successful in 60 patients (56%), either by resection alone (36%), or by SLT for recurrence (19%). Preresection predictors of successful SLT strategy at multivariate analysis included Model for End-Stage Liver Disease (MELD) score >10, and absence of neoadjuvant transarterial chemoembolization (TACE). Additional postresection predictive factors were absence of postresection morbidity, and T-stage 1-2 at the resection specimen.
The SLT strategy is curative in only 56% of cases. Higher MELD score at inception of the strategy and no pre-resection TACE are predictors of successful SLT strategy. (Hepatology 2018;67:204-215).
为了避免肝移植（LT），对于最初可切除和可移植（R&T）的肝细胞癌（HCC）患者，提出挽救性肝移植（SLT）策略，作为术后复发的“安全网”。当患者单独接受初始切除后无复发，或因复发接受 SLT 后无复发时，SLT 策略是成功或治愈的。本研究旨在确定 R&T HCC 患者 SLT 策略的治愈潜力，并确定其成功的预测因素。从 1994 年到 2012 年，所有肝硬化 R&T HCC 患者均纳入 SLT 策略。采用意向治疗（ITT）分析来确定该策略的结果和根据上述定义成功的预测因素。共纳入 110 例患者接受 SLT 策略。63 例患者（57%）在初始切除后出现肿瘤复发，其中 30 例患者可行 SLT（复发移植率=48%）。从初始切除开始，ITT 5 年总生存率和无病生存率分别为 69%和 60%。SLT 策略在 60 例患者中获得成功（56%），其中 36%为单独切除，19%为因复发而行 SLT。多变量分析中，SLT 策略成功的术前预测因素包括终末期肝病模型（MELD）评分>10 分，以及无新辅助经动脉化疗栓塞（TACE）。术后的预测因素为术后无并发症和切除标本 T 分期 1-2。
在本研究中，只有 56%的病例中 SLT 策略是治愈性的。该策略开始时较高的 MELD 评分和术前无 TACE 是 SLT 策略成功的预测因素。
