Lin Chih-Che, Elsarawy Ahmed M, Li Wei-Feng, Lin Ting-Lung, Yong Chee-Chien, Wang Shih-Ho, Wang Chih-Chi, Kuo Fang-Ying, Cheng Yu-Fan, Chen Chao-Long
Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Surgery Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Ann Transplant. 2017 Oct 10;22:602-610. doi: 10.12659/aot.905779.
BACKGROUND Liver transplantation (LT) is the best radical treatment of hepatocellular carcinoma (HCC). Salvage liver transplantation (SalvLT) provides good outcomes for recurrent HCC cases after initial curative liver resection (LR). However, the salvage strategy is not feasible in all situations due to aggressive recurrences. Recently, sequential liver transplantation (SeqLT) was proposed for cases that show adverse pathological features after LR, thus LT is performed pre-emptively before recurrence. In this report, we compared the outcomes of SalvLT and SeqLT for surgical treatment of HCC. MATERIAL AND METHODS One hundred and ten cases underwent LR for HCC, then were subjected to either SalvLT (n=91) or SeqLT (n=19), from January 2001 to December 2015. For cases that underwent several LR before LT, we collected the data of the last LR before transplantation. A comparison was made according to pre- and post-transplant clinical and pathological variables. Survival analysis and comparison between both pathways are provided. RESULTS The median interval (months) between LR and LT for the SeqLT group and the SalvLT group were 9.6 and 22.2, respectively. (p=0.01). The LR histopathological features were similar in both groups. In the SalvLT group, the histopathological comparison between the criteria of last LR and the criteria of liver explants revealed that 14 cases advanced from stage I to stage II, one cases from stage I to stage IIIa, one case from stage I to stage IIIb, one case from stage I to stage IIIc, three cases from stage II to stage IIIb and one case from stage II to stage IIIc. The overall rate of pathological upstaging in the SalvLT group was 27%. The incidence of post-transplant HCC recurrence was 5% (1/19) and 11% (10/91) for the SeqLT and SalvLT groups, respectively (p=0.4). The incidence of post-LT in-hospital mortality was 0% among the SeqLT group and 2% (2/91) among the SalvLT group. The estimated rates of five-year overall survival and cancer specific survival for the SeqLT group versus the SalvLT group were (92.3% versus 87.6%; p=0.4) and (92.3% versus 91.9%; p=0.7), respectively. CONCLUSIONS The SeqLT approach might be associated with low incidence of cancer recurrence, better overall survival, and less operative mortality. Another possible benefit is the avoidance of aggressive non-transplantable HCC recurrences. More studies and/or randomization are required for highre evidence conclusions.
肝移植（LT）是肝细胞癌（HCC）的最佳根治性治疗方法。挽救性肝移植（SalvLT）为初始根治性肝切除（LR）后复发的HCC患者带来了良好的治疗效果。然而，由于复发进展迅速，挽救策略并非在所有情况下都可行。最近，对于LR后出现不良病理特征的患者，提出了序贯肝移植（SeqLT），即在复发前抢先进行LT。在本报告中，我们比较了SalvLT和SeqLT治疗HCC的手术效果。
2001年1月至2015年12月期间，110例HCC患者接受了LR，随后接受了SalvLT（n = 91）或SeqLT（n = 19）。对于在LT前接受过多次LR的患者，我们收集了移植前最后一次LR的数据。根据移植前后的临床和病理变量进行比较。提供了生存分析以及两种治疗途径之间的比较。
SeqLT组和SalvLT组LR与LT之间的中位间隔时间（月）分别为9.6和22.2（p = 0.01）。两组的LR组织病理学特征相似。在SalvLT组中，最后一次LR的标准与肝外植体的标准之间的组织病理学比较显示，14例从I期进展到II期，1例从I期进展到IIIa期，1例从I期进展到IIIb期，1例从I期进展到IIIc期，3例从II期进展到IIIb期，1例从II期进展到IIIc期。SalvLT组病理分期上调的总体发生率为27%。SeqLT组和SalvLT组移植后HCC复发的发生率分别为5%（1/19）和11%（10/91）（p = 0.4）。SeqLT组移植后住院死亡率为0%，SalvLT组为2%（2/91）。SeqLT组与SalvLT组的估计五年总生存率和癌症特异性生存率分别为（92.3%对87.6%；p = 0.4）和（92.3%对91.9%；p = 0.7）。
SeqLT方法可能与癌症复发率低、总生存率更高和手术死亡率更低相关。另一个可能的好处是避免了侵袭性的不可移植HCC复发。需要更多的研究和/或随机对照试验以得出更有证据的结论。
