肝细胞癌挽救性移植手术治疗模式的转变

Changing Paradigm in the Surgical Management of Hepatocellular Carcinoma With Salvage Transplantation.

作者信息

Ma K W, Chan A C Y, She B W H, Chok K S H, Cheung T T, Dai J W C, Fung J Y Y, Lo C M

机构信息

Department of Surgery, The University of Hong Kong, Hong Kong, China.

出版信息

Transplant Proc. 2018 May;50(4):1087-1093. doi: 10.1016/j.transproceed.2018.01.025.

DOI:10.1016/j.transproceed.2018.01.025

PMID:29731072

Abstract

OBJECTIVE

The objective of this study was to compare the long-term outcomes of primary and salvage liver transplantation for patients with hepatocellular carcinoma (HCC).

METHOD

This was a 10-year retrospective analysis in a tertiary referral center.

RESULTS

There were 184 patients recruited (primary liver transplantation [pLT]:salvage liver transplantation [sLT], 143:41). The median follow-up time was 79 months. Operation time was shorter in the pLT group than the sLT group (661 ± 164 minutes vs 754 ± 206 minutes; P = .01) and the blood loss was 3749 mL and 3545 mL for pLT and sLT, respectively (P = .735). The reoperation rate was 5.6% and 4.9%, respectively (P = 1.0). The 5-year overall and disease-free survival rates from the time of transplantation for pLT and sLT were 84.1% versus 70.2% (P = .01) and 82.2% versus 65.8% (P = .01), respectively. The 5-year overall survival rate from the time of primary treatment for sLT was 80.3% (P = .1). Subgroup analysis of sLT showed that young age (50 vs 56 year old; P = .004) was the only factor associated with poor overall survival. Young age (P = .004) and microvascular permeation (P = .008) in the recurrent tumor were associated with HCC recurrence. Young age stands out to be the only independent factor associated with HCC recurrence.

CONCLUSION

sLT is the treatment of choice for patients with recurrent HCC in regions of graft shortage.

摘要

目的

本研究的目的是比较肝细胞癌（HCC）患者初次肝移植和挽救性肝移植的长期疗效。

方法

这是在一家三级转诊中心进行的为期10年的回顾性分析。

结果

共纳入184例患者（初次肝移植[pLT]：挽救性肝移植[sLT]，143:41）。中位随访时间为79个月。pLT组的手术时间短于sLT组（661±164分钟对754±206分钟；P = .01），pLT和sLT的失血量分别为3749 mL和3545 mL（P = .735）。再次手术率分别为5.6%和4.9%（P = 1.0）。pLT和sLT移植后5年的总生存率和无病生存率分别为84.1%对70.2%（P = .01）和82.2%对65.8%（P = .01）。sLT初次治疗后5年的总生存率为80.3%（P = .1）。sLT的亚组分析显示，年轻（50岁对56岁；P = .004）是与总体生存不良相关的唯一因素。复发性肿瘤中的年轻（P = .004）和微血管浸润（P = .008）与HCC复发相关。年轻是与HCC复发相关的唯一独立因素。