Hong Suk Kyun, Lee Kwang-Woong, Yoon Kyung Chul, Kim Hyo-Sin, Ahn Sung-Woo, Kim Hyeyoung, Lee Jeong-Moo, Cho Jae-Hyung, Yi Nam-Joon, Suh Kyung-Suk
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Surgery, Division of HBP Surgery & Liver Transplantation, Anam Hospital, Korea University College of Medicine, Seoul, Korea.
Clin Transplant. 2019 Oct;33(10):e13703. doi: 10.1111/ctr.13703. Epub 2019 Sep 25.
Some patients with hepatocellular carcinoma (HCC) recurrence after LT show good long-term survival. We aimed to determine the prognostic factors affecting survival after recurrence and to suggest treatment strategies.
Between January 2000 and December 2015, 532 patients underwent adult living donor liver transplantation (LDLT) for HCC. Among these, 92 (17.3%) who experienced recurrence were retrospectively reviewed.
The 1-, 3-, and 5-year survival rates after recurrence were 59.5%, 23.0%, and 11.9%, respectively. In multivariate analysis, time to recurrence >6 months and surgical resection after recurrence were related to longer survival after recurrence, while multi-organ involvement at the time of primary recurrence was related to poorer survival. We classified patients into early (≤6 months) and late (>6 months) recurrence groups. In the early recurrence group, tumor size >5 cm in the explant liver, liver as the first detected site of recurrence, and multiple organ involvement at primary recurrence were related to survival on multivariate analysis. In the late recurrence group, mammalian target of rapamycin inhibitor (mTORi) usage and multi-organ involvement were significantly associated with the prognosis on multivariate analysis.
Various therapeutic approaches are needed depending on the period of recurrence after LT and multiplicity of involved organs.
一些肝细胞癌（HCC）患者肝移植（LT）后复发仍有良好的长期生存率。我们旨在确定影响复发后生存的预后因素并提出治疗策略。
2000年1月至2015年12月期间，532例患者因HCC接受成人活体肝移植（LDLT）。其中，对92例（17.3%）复发患者进行回顾性分析。
复发后的1年、3年和5年生存率分别为59.5%、23.0%和11.9%。多因素分析显示，复发时间>6个月及复发后手术切除与复发后更长生存期相关，而初次复发时多器官受累与较差的生存相关。我们将患者分为早期（≤6个月）和晚期（>6个月）复发组。在早期复发组中，移植肝肿瘤大小>5 cm、肝脏为首次检测到的复发部位以及初次复发时多器官受累在多因素分析中与生存相关。在晚期复发组中，多因素分析显示使用雷帕霉素靶蛋白抑制剂（mTORi）和多器官受累与预后显著相关。
根据LT后复发时间及受累器官的情况，需要采取不同的治疗方法。
