Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil; São Paulo Clinicas Liver Cancer Group, São Paulo, Brazil.
Department of Gastroenterology, Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
Ann Hepatol. 2021 May-Jun;22:100294. doi: 10.1016/j.aohep.2020.100294. Epub 2020 Dec 1.
Hepatocellular carcinoma (HCC) is one of the main indications for orthotopic liver transplantation (OLT). In Brazil, selection criteria for HCC is an expanded version of the Milan Criteria (MC), the so-called "Brazilian Milan Criteria" (BMC). Our aims were to evaluate post-OLT outcomes in patients with HCC and analyze the BMC performance.
We conducted a multicenter, retrospective cohort study, analyzing medical records of 1,059 liver transplant recipients with HCC. Tumor was staged according to MC and BMC and correlated with overall survival (OS) and disease-free survival (DFS). We compared the ability of MC and BMC to predict OS and DFS using Delta C-statistic.
Post-OLT OS were 63% in five years and HCC recurrence was observed in 8% of patients. At diagnosis, 85% of patients were within MC. Patients within MC at diagnosis and in the explant showed a higher OS and DFS than patients outside MC and within BMC and patients outside both criteria (p < 0.001). Patients outside MC in the explant had an increased risk of tumor recurrence (HR: 3.78; p < 0.001) and poor survival (HR:1.77; p = 0.003). The BMC presented a lower performance than MC in properly classifying patients regarding recurrence risk.
In a large Brazilian cohort of HCC patients submitted to liver transplantation, we observed satisfactory overall survival and recurrence rates. However, patients transplanted within the Brazilian expanded criteria had lower OS and DFS when compared to patients within MC, which may generate future discussions regarding the criteria currently used.
肝细胞癌（HCC）是原位肝移植（OLT）的主要适应证之一。在巴西，HCC 的选择标准是米兰标准（MC）的扩展版本，即所谓的“巴西米兰标准”（BMC）。我们的目的是评估 HCC 患者接受 OLT 后的结局，并分析 BMC 的表现。
我们进行了一项多中心、回顾性队列研究，分析了 1059 例 HCC 肝移植受者的病历。肿瘤分期依据 MC 和 BMC，并与总生存期（OS）和无病生存期（DFS）相关。我们使用 Delta C-统计量比较 MC 和 BMC 预测 OS 和 DFS 的能力。
OLT 后 5 年 OS 为 63%，8%的患者出现 HCC 复发。在诊断时，85%的患者符合 MC。在诊断和肝移植时符合 MC 的患者的 OS 和 DFS 高于不符合 MC 但符合 BMC 以及不符合 MC 和 BMC 的患者（p<0.001）。在肝移植时不符合 MC 的患者发生肿瘤复发的风险增加（HR：3.78；p<0.001），生存状况较差（HR：1.77；p=0.003）。BMC 在正确分类复发风险方面的表现低于 MC。
在接受肝移植的大量巴西 HCC 患者队列中，我们观察到了令人满意的总体生存率和复发率。然而，与符合 MC 的患者相比，符合巴西扩展标准的患者的 OS 和 DFS 较低，这可能会引发关于目前使用标准的未来讨论。
