Ziogas Ioannis A, Benedetti Daniel J, Matsuoka Lea K, Izzy Manhal, Rauf Muhammad A, Pai Anita K, Bailey Christina E, Alexopoulos Sophoclis P
Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Department of Pediatrics, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
J Pediatr Surg. 2021 Apr;56(4):772-777. doi: 10.1016/j.jpedsurg.2020.06.013. Epub 2020 Jun 18.
This study evaluates overall survival (OS) between liver transplantation (LT) and liver resection (LR), while assessing the effect of margin status, in children with hepatocellular carcinoma (HCC).
The National Cancer Database was queried (2004-2015) for children (<18 years) with non-metastatic HCC undergoing surgery.
One hundred six children with HCC treated surgically (LT 34, LR 72) were identified. For T1 stage, no difference in OS was observed for LT vs. margin-negative liver resection [LR(-)] (log-rank, p = 0.47). For T2/T3/T4 stage, no difference in OS was observed for LT vs. LR(-) (log-rank, p = 0.08); both subgroups exhibited superior OS vs. margin-positive liver resection [LR(+)] (log-rank, LT vs. LR(+): p = 0.001 and LR(-) vs. LR(+): p = 0.04). On multivariable Cox regression: (i) histology (fibrolamellar vs. not) and T stage (T1 vs. T2/T3/T4) were not associated with OS (both p = 0.06), (ii) chemotherapy and size >5 cm were not associated with OS (both p ≥ 0.42), (iii) when compared to LT, both LR(-) (p = 0.03) and LR(+) (p = 0.001) were associated with increased likelihood of mortality.
Although margin-negative resection may be obtained with LT or LR, early LT consultation is warranted for children at high risk of LR(+) regardless of Milan criteria due to the negative impact of LR(+) on OS.
Retrospective cohort study.
III.
本研究评估肝细胞癌（HCC）患儿肝移植（LT）和肝切除（LR）后的总生存期（OS），同时评估切缘状态的影响。
查询国家癌症数据库（2004 - 2015年）中接受手术的非转移性HCC患儿（<18岁）。
共确定106例接受手术治疗的HCC患儿（LT 34例，LR 72例）。对于T1期，LT与切缘阴性肝切除[LR(-)]的OS无差异（对数秩检验，p = 0.47）。对于T2/T3/T4期，LT与LR(-)的OS无差异（对数秩检验，p = 0.08）；两个亚组的OS均优于切缘阳性肝切除[LR(+)]（对数秩检验，LT与LR(+)：p = 0.001，LR(-)与LR(+)：p = 0.04）。多变量Cox回归分析显示：（i）组织学类型（纤维板层型与非纤维板层型）和T分期（T1与T2/T3/T4）与OS无关（p均 = 0.06），（ii）化疗和肿瘤大小>5 cm与OS无关（p均≥0.42），（iii）与LT相比，LR(-)（p = 0.03）和LR(+)（p = 0.001）均与死亡可能性增加相关。
尽管LT或LR均可实现切缘阴性切除，但由于LR(+)对OS有负面影响，对于有LR(+)高风险的患儿，无论米兰标准如何,均需早期咨询肝移植。
回顾性队列研究。
III级。
