Harimoto Norifumi, Yoshizumi Tomoharu, Fujimoto Yukiko, Motomura Takashi, Mano Youhei, Toshima Takeo, Itoh Shinji, Harada Noboru, Ikegami Toru, Uchiyama Hideaki, Soejima Yuji, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
World J Surg. 2018 Aug;42(8):2606-2616. doi: 10.1007/s00268-018-4493-1.
Liver transplantation has been established as the optimal treatment for hepatocellular carcinoma in cirrhotic patients, but hepatic resection is also effective in patients with well-preserved liver function. Determining the suitable surgical treatment for patients with Child-Pugh class B cirrhosis is a more difficult challenge.
We retrospectively compared the results of hepatic resection and living donor liver transplantation for hepatocellular carcinoma in 137 patients with Child-Pugh class B cirrhosis. The procedures were performed at Kyushu University Hospital from April 2014 through October 2016.
Patients who underwent hepatic resection were significantly older and had better liver function, larger tumor size, smaller number of tumors, and less surgical stress compared with patients who underwent living donor liver transplantation. The overall survival rate and the recurrence-free survival rate in patients with transplantation were significantly better than that in patients with resection. The multivariate analysis showed that recurrent hepatocellular carcinoma and microvascular invasion were significant prognostic factors for both overall and recurrence-free survival in the hepatic resection group. In the group with protein induced by vitamin K absence or antagonist-II ≥300 mAU/mL, both the overall survival curve and the recurrence-free survival curve in patients with living donor liver transplantation were not significantly different from those in patients with hepatic resection.
Living donor liver transplantation for hepatocellular carcinoma in patients with Child-Pugh class B cirrhosis was favorable under the condition of protein induced by vitamin K absence or antagonist-II <300 mAU/mL in selected recipients and donors. Hepatic resection for recurrent hepatocellular carcinoma and excessive blood loss should be avoided in patients with Child-Pugh class B cirrhosis.
肝移植已被确立为肝硬化患者肝细胞癌的最佳治疗方法，但肝切除对肝功能良好的患者也有效。确定Child-Pugh B级肝硬化患者的合适手术治疗是一项更具挑战性的难题。
我们回顾性比较了137例Child-Pugh B级肝硬化肝细胞癌患者肝切除和活体肝移植的结果。手术于2014年4月至2016年10月在九州大学医院进行。
与接受活体肝移植的患者相比，接受肝切除的患者年龄显著更大，肝功能更好，肿瘤尺寸更大，肿瘤数量更少，手术应激更小。移植患者的总生存率和无复发生存率显著优于切除患者。多因素分析显示，复发性肝细胞癌和微血管侵犯是肝切除组总生存和无复发生存的重要预后因素。在维生素K缺乏或拮抗剂-II诱导蛋白≥300 mAU/mL的组中，活体肝移植患者的总生存曲线和无复发生存曲线与肝切除患者的无显著差异。
在选定受者和供者中，当维生素K缺乏或拮抗剂-II诱导蛋白<300 mAU/mL时，Child-Pugh B级肝硬化肝细胞癌患者进行活体肝移植是有利的。Child-Pugh B级肝硬化患者应避免对复发性肝细胞癌进行肝切除以及避免失血过多。
