Nomura Aya, Ishigami Masatoshi, Honda Takashi, Kuzuya Teiji, Ishizu Yoji, Ito Takanori, Kamei Hideya, Onishi Yasuharu, Ogura Yasuhiro, Fujishiro Mitsuhiro
Department of Gastroenterology and Hepatology.
Department of Transplant Surgery, Nagoya University School of Medicine, Nagoya, Japan.
Medicine (Baltimore). 2020 Jul 10;99(28):e21161. doi: 10.1097/MD.0000000000021161.
In this study, we investigated the long-term survival of patients with hepatocellular carcinoma (HCC) after conventional treatment other than liver transplantation (LT) in our institute and discuss the limitation of non-transplant treatment for HCC and the proper indictors of LT in the recent comprehensive era.Between 2003 and 2016, 181 patients with HCC aged ≦70 years received active treatment including liver resection, radiofrequency ablation (RFA), and transcatheter arterial chemoembolization (TACE). We analyzed the factors associated with overall survival and proposed new priority for the indicators of LT in HCC patients according to the extracted factors by comparing the survival with 39 transplanted patients with HCC.Child-Turcotte-Pugh (CTP) score (HR: 1.276; 95% CI: 1.049-1.552, P = .015), and number of tumors (HR: 1.238; 95% CI: 1.112-1.377, P < .001) were selected as significant factors associated with the survival after active treatments for HCC. Patients with LT had significantly better long-term survival compared with those with non-transplant patients regardless of aforementioned factors. However, regarding relatively short survival (3 years), patients with CTP score of ≧9 and/or ≧3 tumors with non-transplant treatment had poorer survival compared with those of transplanted patients (P < .05).We propose that CTP score of 9 and/or 3 tumors before non-transplant, intensive treatment might be a new priority for considering indicators of LT in patients with HCC.
在本研究中，我们调查了我院肝细胞癌（HCC）患者在接受肝移植（LT）以外的传统治疗后的长期生存情况，并讨论了HCC非移植治疗的局限性以及当前综合时代LT的合适指标。2003年至2016年期间，181例年龄≤70岁的HCC患者接受了包括肝切除、射频消融（RFA）和经动脉化疗栓塞（TACE）在内的积极治疗。我们分析了与总生存相关的因素，并通过将生存情况与39例接受移植的HCC患者进行比较，根据提取的因素提出了HCC患者LT指标的新优先级。Child-Turcotte-Pugh（CTP）评分（HR：1.276；95%CI：1.049-1.552，P = 0.015）和肿瘤数量（HR：1.238；95%CI：1.112-1.377，P < 0.001）被选为与HCC积极治疗后生存相关的显著因素。无论上述因素如何，接受LT的患者与非移植患者相比，长期生存明显更好。然而，对于相对较短的生存期（3年），非移植治疗的CTP评分≥9和/或肿瘤数量≥3的患者与移植患者相比，生存较差（P < 0.05）。我们提出，非移植、强化治疗前CTP评分为9和/或肿瘤数量为3可能是考虑HCC患者LT指标的新优先级。
