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小儿肝母细胞瘤和肝细胞癌肝移植的当代疗效改善

Improved contemporary outcomes of liver transplantation for pediatric hepatoblastoma and hepatocellular carcinoma.

作者信息

Ezekian Brian, Mulvihill Michael S, Schroder Paul M, Gilmore Brian F, Leraas Harold J, Gulack Brian C, Jane Commander Sarah, Mavis Alisha M, Kreissman Susan G, Knechtle Stuart J, Tracy Elisabeth T, Barbas Andrew S

机构信息

Department of Surgery, Duke University Medical Center, Durham, North Carolina.

Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.

出版信息

Pediatr Transplant. 2018 Dec;22(8):e13305. doi: 10.1111/petr.13305. Epub 2018 Oct 19.

DOI:10.1111/petr.13305

PMID:30341782

Abstract

PURPOSE

Improvement in outcomes of LT for pediatric HB and HCC has been reported in small series. We analyzed national outcomes and changes in donor, recipient, and perioperative factors over time that may contribute to survival differences.

METHODS

The UNOS database was queried for patients age <21 years that underwent LT for a primary diagnosis of HB or HCC (1987-2017). Subjects were divided into historic (transplant before 2010) and contemporary (transplant after 2010) cohorts. Baseline characteristics were compiled and examined. Survival was estimated using the Kaplan-Meier method and compared using the log-rank test.

RESULTS

In total, 599 children with HB received LT (320 historic vs 279 contemporary). Concurrently, 141 children with HCC received LT (92 historic vs 49 contemporary). For both tumors, waitlist time decreased (HB 56.2 days historic vs 33.2 days contemporary, P = 0.017; HCC 189.3 days historic vs 71.7 days contemporary, P = 0.012). In the historic cohorts, patients with HB had a 1-year and 5-year OS of 84.6% and 75.1%, respectively. Survival for HCC was 84.4% and 59.9%, respectively. Outcomes improved in the contemporary era to 89.1% and 82.6% for HB, and 94.7% and 80.8% for HCC, respectively (both log-rank test P < 0.0001).

CONCLUSION

Outcomes of LT have improved significantly, with contemporary survival now equivalent between these tumors and exceeding 80% 5-year OS. Future studies are needed to explore whether offering LT in patients that are resectable is justifiable.

摘要

目的

已有小规模研究报告称，小儿肝母细胞瘤（HB）和肝癌（HCC）肝移植（LT）的治疗效果有所改善。我们分析了全国范围内的治疗结果以及随着时间推移供体、受体和围手术期因素的变化，这些因素可能导致生存差异。

方法

查询器官共享联合网络（UNOS）数据库，获取年龄小于21岁、因HB或HCC的初步诊断而接受LT的患者（1987 - 2017年）。受试者被分为历史队列（2010年前移植）和当代队列（2010年后移植）。收集并检查基线特征。使用Kaplan-Meier方法估计生存率，并使用对数秩检验进行比较。

结果

共有599例HB患儿接受了LT（历史队列320例，当代队列279例）。同时，141例HCC患儿接受了LT（历史队列92例，当代队列49例）。对于这两种肿瘤，等待名单时间均有所减少（HB：历史队列56.2天，当代队列33.2天，P = 0.017；HCC：历史队列189.3天，当代队列71.7天，P = 0.012）。在历史队列中，HB患者的1年和5年总生存率分别为84.6%和75.1%。HCC的生存率分别为84.4%和59.9%。在当代，HB的治疗效果分别提高到89.1%和82.6%，HCC分别提高到94.7%和80.8%（对数秩检验P均<0.0001）。