Department of Liver Surgery and Liver Transplantation Centre, West China Hospital of Sichuan University, Guoxuexiang 37, Chengdu 610041, Sichuan Province, China.
Department of Liver Surgery and Liver Transplantation Centre, West China Hospital of Sichuan University, Guoxuexiang 37, Chengdu 610041, Sichuan Province, China.
Int J Surg. 2017 Oct;46:178-185. doi: 10.1016/j.ijsu.2017.09.001. Epub 2017 Sep 7.
The optimal treatment strategy for patients with recurrent hepatocellular carcinoma (HCC) remains unclear. This study was designed to investigate the outcomes of salvage liver transplantation (SLT) and re-resection (RR)/radiofrequency ablation (RFA) with respect to the time to recurrence after initial curative resection.
Between 2007 and 2016, 756 patients underwent curative hepatectomy for HCC in accordance with the Milan criteria. Among them, 152 experienced an intrahepatic recurrence and underwent SLT (n = 36) and RR/RFA (n = 116). Clinical data, overall survival (OS), and disease-free survival (DFS) (including subgroup analyses) according to the time to recurrence were statistically compared between the 2 groups, and prognostic factors were identified.
The DFS of the patients who underwent SLT was much better than that of the patients who underwent RR/RFA (P = 0.002), particularly those with late recurrence (more than 12 months, P = 0.004). The time to recurrence from initial hepatectomy was found to be an independent predictor of OS and DFS.
SLT, rather than re-resection or RFA, should be the preferred treatment option for patients with late recurrence.
对于复发性肝细胞癌（HCC）患者，最佳治疗策略仍不明确。本研究旨在探讨初始根治性切除术后复发时间与挽救性肝移植（SLT）和再次切除（RR）/射频消融（RFA）的结果关系。
2007 年至 2016 年间，根据米兰标准，756 例 HCC 患者接受了根治性肝切除术。其中 152 例患者发生肝内复发，并接受了 SLT（n=36）和 RR/RFA（n=116）。对两组患者的临床数据、总生存期（OS）和无病生存期（DFS）（包括亚组分析）进行统计学比较，并确定预后因素。
SLT 组患者的 DFS 明显优于 RR/RFA 组（P=0.002），尤其是那些复发时间较晚（超过 12 个月，P=0.004）的患者。从初始肝切除术到复发的时间是 OS 和 DFS 的独立预测因素。
对于复发时间较晚的患者，SLT 应作为首选治疗方法，而非再次切除或 RFA。
