Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; NHC Key Laboratory of Combined Multi-organ Transplantation, Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, Hangzhou 310003, China.
Department of Hepatic Surgery and Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
Hepatobiliary Pancreat Dis Int. 2020 Aug;19(4):349-357. doi: 10.1016/j.hbpd.2020.06.011. Epub 2020 Jun 21.
The downstaging of hepatocellular carcinoma (HCC) has been confirmed to benefit liver transplantation (LT) patients whose tumors are beyond the transplantation criteria. Milan criteria (MC), a tumor size and number-based assessment, is currently used as the endpoint in these patients. However, many studies believe that tumor biological behavior should be added to the evaluation criteria for downstaging efficacy. Hence, this study aimed to explore the feasibility of Hangzhou criteria (HC), which introduced tumor grading and alpha-fetoprotein in addition to tumor size and number, as an endpoint of downstaging.
We performed a multicenter and retrospective study of 206 patients accepted locoregional therapy (LRT) as downstaging/bridge treatment prior to LT in three centers of China.
Recipients were divided into four groups: failed downstaging to the HC (group A, n = 46), successful downstaging to the HC (group B, n = 30), remained within the HC all the time (group C, n = 113), and tumor progressed (group D, n = 17). The 3-year HCC recurrence probabilities of groups B and C were not significantly different (10.3% vs. 11.6%, P = 0.87). The HCC recurrent rate was significantly higher in group A (52.3%) compared with that in group B/C (P < 0.05). Seven patients (7/76, 9.2%) whose tumor exceeded the the HC were successfully downstaged to the MC, and 39.5% (30/76) to the the HC. In group B, 23 patients remained beyond the MC and their survivals were as well as those of patients within the MC.
Compared to the MC, HC downstaging criteria can give more HCC patients access to LT and furthermore, the outcome of these patients is the same as those matching MC downstaging criteria. Hangzhou downstaging criteria therefore is applicable in clinical practice.
肝癌（HCC）的降期已被证实有益于超出移植标准的肿瘤患者进行肝移植（LT）。米兰标准（MC），一种基于肿瘤大小和数量的评估，目前被用作这些患者的终点。然而，许多研究认为，肿瘤生物学行为应该被添加到降期疗效的评估标准中。因此，本研究旨在探讨杭州标准（HC）的可行性，该标准除了肿瘤大小和数量外，还引入了肿瘤分级和甲胎蛋白作为降期的终点。
我们在中国的三个中心进行了一项多中心回顾性研究，共纳入 206 名接受局部区域治疗（LRT）作为降期/桥接治疗的患者。
受者被分为四组：未能降期至 HC（A 组，n=46）、成功降期至 HC（B 组，n=30）、始终处于 HC 范围内（C 组，n=113）和肿瘤进展（D 组，n=17）。B 组和 C 组的 3 年 HCC 复发率无显著差异（10.3%比 11.6%，P=0.87）。A 组的 HCC 复发率明显高于 B/C 组（52.3%比 10.3%，P<0.05）。7 例（7/76，9.2%）肿瘤超出 HC 的患者成功降期至 MC，39.5%（30/76）降期至 HC。在 B 组，23 例患者仍超出 MC，其生存情况与 MC 内患者相同。
与 MC 相比，HC 降期标准可以让更多的 HCC 患者获得 LT，并且这些患者的预后与符合 MC 降期标准的患者相同。因此，杭州降期标准适用于临床实践。
