Barcelona Clinic Liver Cancer Group, Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain.
Mount Sinai Liver Cancer Program, Icahn School of Medicine at Mount Sinai, New York, NY.
Liver Transpl. 2018 Mar;24(3):369-379. doi: 10.1002/lt.24977.
A subset of patients with hepatocellular carcinoma (HCC) beyond Milan criteria might obtain acceptable survival outcomes after liver transplantation. Living donor liver transplantation (LDLT) has emerged as a feasible alternative to overcome the paucity of donors. In 2001, we started a protocol for LDLT in Child A-B patients with HCC fulfilling a set of criteria-the Barcelona Clinic Liver Cancer (BCLC) expanded criteria-that expanded the conventional indications of transplantation: 1 tumor ≤ 7 cm, 5 tumors ≤ 3 cm, and 3 tumors ≤ 5 cm without macrovascular invasion or downstaging to Milan after locoregional therapies. We present a prospective cohort of 22 patients with BCLC extended indications based on size/number (n = 17) or downstaging (n = 5) treated with LDLT between 2001 and 2014. Characteristics of the patients were as follows: median age, 57 years old; males/female, n = 20/2; Child-Pugh A/B, n = 16/6; and alpha fetoprotein < 100 ng/mL, n = 21. Twelve patients received neoadjuvant locoregional therapies. At the time of transplantation, 12 patients had HCC staging beyond Milan criteria and 10 within. Pathological reports showed that 50% exceeded BCLC expanded criteria. Perioperative mortality was 0%. After a median follow-up of 81 months, the 1-, 3-, 5-, and 10-year survival was 95.5%, 86.4%, 80.2%, and 66.8%, respectively. Overall, 7 patients recurred (range, 9-108 months), and the 5-year and 10-year actuarial recurrence rates were 23.8% and 44.4%, respectively. In conclusion, a proper selection of candidates for extended indications of LDLT for HCC patients provide survival outcomes comparable to those obtained within the Milan criteria, but these results need confirmation. Liver Transplantation 24 369-379 2018 AASLD.
对于超出米兰标准的肝细胞癌（HCC）患者，肝移植后可能获得可接受的生存结果。活体供肝移植（LDLT）已成为克服供体短缺的可行替代方法。2001 年，我们开始了一项针对符合一组标准的 Child A-B 期 HCC 患者的 LDLT 方案，这些标准是巴塞罗那临床肝癌（BCLC）扩展标准，扩大了移植的传统适应证：1 个肿瘤≤7cm，5 个肿瘤≤3cm，3 个肿瘤≤5cm，无大血管侵犯或局部区域治疗后降级为米兰标准。我们提出了一项前瞻性队列研究，纳入了 2001 年至 2014 年间接受 LDLT 治疗的 22 名符合 BCLC 扩展适应证的患者，这些患者的依据是肿瘤大小/数量（n=17）或降级（n=5）。患者的特征如下：中位年龄 57 岁；男/女，n=20/2；Child-Pugh A/B，n=16/6；甲胎蛋白<100ng/mL，n=21。12 例患者接受了新辅助局部区域治疗。在移植时，12 例患者的 HCC 分期超出米兰标准，10 例患者的 HCC 分期在米兰标准内。病理报告显示，50%的患者超出了 BCLC 扩展标准。围手术期死亡率为 0%。中位随访 81 个月后，1、3、5 和 10 年生存率分别为 95.5%、86.4%、80.2%和 66.8%。总的来说，7 例患者复发（范围为 9-108 个月），5 年和 10 年累积复发率分别为 23.8%和 44.4%。总之，对 HCC 患者的 LDLT 扩展适应证进行适当选择，可以获得与米兰标准内相似的生存结果，但这些结果需要进一步证实。肝移植 24 369-379 2018 AASLD。
