Meyerovich Guy, Goykhman Yaacov, Nakache Richard, Nachmany Ido, Lahat Guy, Shibolet Oren, Menachem Yoram, Katchman Helena, Wolf Ido, Geva Ravit, Klausner Joseph M, Lubezky Nir
Department of Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.
Institute of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel.
Transplant Proc. 2019 Jul-Aug;51(6):1867-1873. doi: 10.1016/j.transproceed.2019.02.030.
Liver transplantation (LT) and liver resection (LR) are curative treatment options for patients with hepatocellular carcinoma within the Milan criteria. Severe organ shortage dictates the preference for LR. Our aim was to provide an intention-to-treat retrospective comparison of survival between patients who were placed on waiting lists for LT and those who underwent LR.
The medical records of patients with hepatocellular carcinoma within the Milan criteria treated by LR or listed for LT between 2007 and 2016 were reviewed. We performed intention-to-treat analyses of overall survival and recurrence.
There were 54 patients on the waiting list for LT, and 30 of them underwent LR. Thirteen of the 54 patients (24%) were not transplanted because of disease-related mortality or tumor progression. The median waiting time to transplantation was 304 days. The 90-day mortality was higher in transplanted patients (9.8% vs 3.3%, P = .003). Intention-to-treat survival was similar for the LT and LR groups (5-year survival, 47.8% vs 55%, respectively, P = .185). There was a trend toward improved 5-year disease-free survival for listed patients (56.2% vs 26.3% for patients undergoing LR, P = .15).
Intention-to-treat survival is similar in patients undergoing LR and those on waiting lists for LT. There is a 24% risk to drop from the transplant list. The higher perioperative mortality among patients undergoing LT is balanced by a higher tumor recurrence rate after LR.
肝移植（LT）和肝切除术（LR）是符合米兰标准的肝细胞癌患者的根治性治疗选择。严重的器官短缺决定了更倾向于选择LR。我们的目的是对等待肝移植的患者和接受肝切除术的患者的生存情况进行意向性治疗的回顾性比较。
回顾了2007年至2016年间接受LR治疗或列入肝移植等待名单的符合米兰标准的肝细胞癌患者的病历。我们对总生存和复发情况进行了意向性治疗分析。
有54名患者在等待肝移植名单上，其中30名接受了肝切除术。54名患者中有13名（24%）因疾病相关死亡率或肿瘤进展而未接受移植。移植的中位等待时间为304天。移植患者的90天死亡率更高（9.8%对3.3%，P = .003）。肝移植组和肝切除组的意向性治疗生存率相似（5年生存率分别为47.8%和55%，P = .185）。列入名单的患者5年无病生存率有改善的趋势（接受肝切除术的患者为56.2%对26.3%，P = .15）。
接受肝切除术的患者和等待肝移植的患者的意向性治疗生存率相似。有24%的风险从移植名单上退出。肝移植患者围手术期较高的死亡率与肝切除术后较高的肿瘤复发率相平衡。
