Department of Oncology, Oslo University Hospital, Oslo, Norway.
Department of Mathematics and Natural Science, University of Stavanger, Stavanger, Norway.
Br J Surg. 2018 May;105(6):736-742. doi: 10.1002/bjs.10769. Epub 2018 Mar 13.
Liver transplantation is considered the standard of care for patients with hepatocellular carcinoma (HCC) within the Milan criteria. Liver transplantation in patients with unresectable colorectal cancer with liver-only disease has been shown to be associated with a 5-year overall survival rate of 56 per cent, compared with 9 per cent in patients receiving standard palliative chemotherapy. The aim of the present study was to compare disease-free (DFS) and overall (OS) survival after liver transplantation in patients with HCC and those with colorectal metastases.
Data were collected from the SEcondary CAncer (SECA) study database and an institutional (national) database of patients undergoing liver transplantation for HCC; all liver-transplanted patients were included. Patients with colorectal metastases treated by liver transplantation were divided into high- and low-risk groups for mortality based on carcinoembryonic antigen levels, response to chemotherapy, largest lesion at time of transplantation and time from primary surgery to transplantation.
Patients with colorectal metastases had a median of 8 lesions, compared with 1 in patients with HCC within the Milan criteria. DFS was shorter in both the high-risk and the low-risk colorectal cancer groups compared with that in patients with HCC. The 5-year OS rate in the low-risk colorectal cancer group was 75 per cent, compared with 76 per cent in patients with HCC within the Milan criteria. The 5-year OS rate in patients with HCC beyond the Milan criteria was 56 per cent.
The low-risk group of patients with colorectal cancer and unresectable liver-only disease had a 5-year OS rate following liver transplantation similar to that of patients with HCC with lesions within the Milan criteria.
肝移植被认为是符合米兰标准的肝细胞癌（HCC）患者的标准治疗方法。对于仅有肝转移而无法切除的结直肠癌患者，肝移植与接受标准姑息化疗的患者相比，5 年总生存率为 56%，而后者为 9%。本研究旨在比较 HCC 患者和结直肠转移患者肝移植后的无病生存（DFS）和总生存（OS）。
从 SECONDARY CAncer（SECA）研究数据库和一个国家机构数据库中收集了接受 HCC 肝移植的患者的数据；所有接受肝移植的患者均被纳入。接受肝移植治疗的结直肠转移患者根据癌胚抗原水平、化疗反应、移植时最大病变和原发手术到移植的时间分为高死亡率和低死亡率两组。
结直肠转移患者的中位数为 8 个病变，而符合米兰标准的 HCC 患者为 1 个病变。DFS 在高风险和低风险结直肠癌组均短于 HCC 患者。低风险结直肠癌组的 5 年 OS 率为 75%，而符合米兰标准的 HCC 患者为 76%。超出米兰标准的 HCC 患者的 5 年 OS 率为 56%。
对于仅有肝转移且无法切除的低危结直肠癌患者，肝移植后的 5 年 OS 率与符合米兰标准的 HCC 患者的病变相似。
