Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation and, Henri Mondor Hospital, AP-HP, Paris-Est University, Créteil, France.
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Liver Transpl. 2017 Dec;23(12):1553-1563. doi: 10.1002/lt.24952.
The salvage liver transplantation (LT) strategy was conceived for initially resectable and transplantable hepatocellular carcinoma (HCC) to obviate upfront transplantation, with salvage LT in the case of recurrence. The longterm outcomes of a second resection for recurrent HCC have improved. The aim of this study was to perform an intention-to-treat analysis of overall survival (OS) comparing these 2 strategies for initially resectable and transplantable recurrent HCC. From 1994 to 2011, 391 patients with HCC who underwent salvage LT (n = 77) or a second resection (n = 314) were analyzed. Of 77 patients in the salvage LT group, 21 presented with resectable and transplantable recurrent HCC and 18 underwent transplantation. Of 314 patients in the second resection group, 81 presented with resectable and transplantable recurrent HCC and 81 underwent a second resection. The 5-year intention-to-treat OS rates, calculated from the time of primary hepatectomy, were comparable between the 2 strategies (72% for salvage transplantation versus 77% for second resection; P = 0.57). In patients who completed the salvage LT or second resection procedure, the 5-year OS rates, calculated from the time of the second surgery, were comparable between the 2 strategies (71% versus 71%; P = 0.99). The 5-year disease-free survival (DFS) rates were 72% following transplantation and 18% following the second resection (P < 0.001). Similar results were observed after propensity score matching. In conclusion, although the 5-year OS rates were similar in the salvage LT and second resection groups, the salvage LT strategy still achieves better DFS. Second resection for recurrent HCC might be considered to be the best alternative option to LT in the current organ shortage. Liver Transplantation 23 1553-1563 2017 AASLD.
挽救性肝移植（LT）策略最初是为可切除和可移植的肝细胞癌（HCC）而设计的，以避免 upfront 移植，在复发时进行挽救性 LT。对于复发性 HCC 的再次切除的长期结果已经得到改善。本研究的目的是通过总体生存（OS）的意向治疗分析，比较这两种策略对于最初可切除和可移植的复发性 HCC 的疗效。1994 年至 2011 年，对 391 例 HCC 患者进行了挽救性 LT（n=77）或第二次切除术（n=314），进行了分析。在挽救性 LT 组的 77 例患者中，21 例为可切除和可移植的复发性 HCC，18 例接受了移植。在第二次切除术组的 314 例患者中，81 例为可切除和可移植的复发性 HCC，81 例接受了第二次切除术。从原发性肝切除术开始计算，两种策略的 5 年意向治疗 OS 率相当（挽救性移植为 72%，第二次切除术为 77%；P=0.57）。在完成挽救性 LT 或第二次切除术的患者中，从第二次手术开始计算的 5 年 OS 率，两种策略相当（71%比 71%；P=0.99）。移植后 5 年无疾病生存率（DFS）为 72%，第二次切除后为 18%（P<0.001）。倾向评分匹配后也观察到了类似的结果。总之，尽管挽救性 LT 组和第二次切除术组的 5 年 OS 率相似，但挽救性 LT 策略仍能获得更好的 DFS。在目前器官短缺的情况下，复发性 HCC 的第二次切除术可能是 LT 的最佳替代选择。
