急性肝移植排斥反应治疗后肝细胞癌复发：一项多中心的欧洲经验。
Hepatocellular carcinoma recurrence after acute liver allograft rejection treatment: A multicenter European experience.
机构信息
Starzl Unit of Abdominal Transplantation, University Hospitals Saint Luc, Université catholique Louvain, Brussels, Belgium; Hepato-biliary Surgery and Liver Transplantation Unit, Sapienza University of Rome, Umberto I Hospital, Rome, Italy.
Starzl Unit of Abdominal Transplantation, University Hospitals Saint Luc, Université catholique Louvain, Brussels, Belgium; Department of Bio-technological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
出版信息
Hepatobiliary Pancreat Dis Int. 2019 Dec;18(6):517-524. doi: 10.1016/j.hbpd.2019.05.006. Epub 2019 May 20.
BACKGROUND
During the last decades, several risk factors for the recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) have been investigated. However, the impact of two important drivers of oncogenesis, namely the immunosuppression and the treatment of acute cellular rejection (ACR) have been marginally addressed. This study aimed at investigating the impact of ACR treatment on the incidence of tumor recurrence in a large European HCC-LT population.
METHODS
Seven hundred and eighty-one adult patients transplanted between February 1, 1985 and June 30, 2016 were retrospectively analyzed. After propensity score match, 116 patients treated for ACR using steroid boluses were compared with 115 patients who did not present any ACR or a histologic but clinical irrelevant ACR.
RESULTS
Steroid boluses treated patients had a 18-fold higher overall incidence of HCC recurrence than those non-treated patients (16.4% vs. 0.9%; P<0.0001). At multivariate Cox regression analysis, steroid boluses used to treat ACR were an independent risk factor for HCC recurrence (HR=14.2; 95% CI: 1.8-110.4; P = 0.010).
CONCLUSIONS
The decision to treat ACR as well as to reinforce immunosuppression load should be cautiously taken in view of the presented results. Prospective studies are needed to further elucidate the clinical impact of immunosuppression on HCC recurrence after transplantation.
背景
在过去的几十年中，已经研究了几种与肝移植（LT）后肝细胞癌（HCC）复发相关的危险因素。然而，肿瘤发生的两个重要驱动因素，即免疫抑制和急性细胞排斥（ACR）的治疗，其影响仅得到了部分探讨。本研究旨在调查 ACR 治疗对大型欧洲 HCC-LT 人群中肿瘤复发发生率的影响。
方法
回顾性分析了 1985 年 2 月 1 日至 2016 年 6 月 30 日期间接受移植的 781 例成年患者。通过倾向评分匹配后，将 116 例使用类固醇冲击治疗 ACR 的患者与 115 例未出现任何 ACR 或组织学但临床无关 ACR 的患者进行比较。
结果
接受类固醇冲击治疗的患者 HCC 复发的总体发生率比未接受治疗的患者高 18 倍（16.4%比 0.9%；P<0.0001）。多变量 Cox 回归分析显示，用类固醇冲击治疗 ACR 是 HCC 复发的独立危险因素（HR=14.2；95%CI：1.8-110.4；P=0.010）。
结论
鉴于目前的结果，应谨慎决定是否治疗 ACR 以及是否加强免疫抑制负荷。需要前瞻性研究进一步阐明免疫抑制对移植后 HCC 复发的临床影响。
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