肝细胞癌活体肝移植：器官共享联合网络改良TNM分期评估

Living Donor Liver Transplantation for Hepatocellular Carcinoma: Appraisal of the United Network for Organ Sharing Modified TNM Staging.

作者信息

Bhatti Abu Bakar Hafeez, Waheed Anum, Khan Nasir Ayub

机构信息

Division of Hepato-Pancreatico-Biliary Surgery, Shifa International Hospital Islamabad, Islamabad, Pakistan.

Division of Anesthesiology, Shifa International Hospital Islamabad, Islamabad, Pakistan.

出版信息

Front Surg. 2021 Jan 21;7:622170. doi: 10.3389/fsurg.2020.622170. eCollection 2020.

In deceased donor liver transplantation (DDLT), transplant eligibility for T3-T4 HCC requires successful downstaging (DS). Living donor liver transplantation (LDLT) can be considered selectively in these patients without DS, but its role is not defined. The objective of the current study was to assess outcomes of LDLT for HCC based on UNOS staging with no prior DS. Patients who underwent LDLT for HCC ( = 262) were staged based on modified UNOS TNM staging. High-risk factors were identified and 5-year recurrence free survival was compared in patients with T2-T4 HCC. Median follow-up was 30.2 (16.4-46.3) months. Recurrence rate in T1, T2, T3, T4a, and T4b HCC was 0, 10.1, 16.1, 5.9, and 37.5% ( = 0.02), respectively. On multivariate analysis, AFP > 600 ng/mL [HR:11.7, < 0.001] and T4b HCC (macrovascular invasion) [HR = 5.6, = 0.03] were predictors of recurrence. After exclusion of AFP > 600 ng/mL, 5-year RFS for T2, T3, and T4a HCC was 94, 86, and 92% ( = 0.3). Rate of microvascular invasion between T2 and T3 HCC was 24.3 vs. 53.6% ( = 0.005), and between T2 and T4a HCC was 24.3 vs. 36.7% ( = 0.2). Overall, 26 (19.4%) patients were overstaged and 23 (17.1%) were understaged on preoperative imaging. The 5-year RFS in patients with identical preoperative and histopathological staging was 94, 87, and 94% ( = 0.6). LDLT without prior DS leads to comparable survival for UNOS T2, T3, and T4a HCC as long as AFP is < 600 ng/mL.

在 deceased donor liver transplantation (DDLT) 中，T3 - T4 期肝癌患者的移植资格要求成功降期 (DS)。对于这些未进行 DS 的患者，可选择性考虑活体肝移植 (LDLT)，但其作用尚不明确。本研究的目的是评估在未进行过 DS 的情况下，基于 UNOS 分期的 LDLT 治疗肝癌的疗效。对因肝癌接受 LDLT 的患者（n = 262）根据改良的 UNOS TNM 分期进行分期。确定高危因素，并比较 T2 - T4 期肝癌患者的 5 年无复发生存率。中位随访时间为 30.2（16.4 - 46.3）个月。T1、T2、T3、T4a 和 T4b 期肝癌的复发率分别为 0、10.1%、16.1%、5.9% 和 37.5%（P = 0.02）。多因素分析显示，AFP > 600 ng/mL [HR:11.7, P < 0.001] 和 T4b 期肝癌（大血管侵犯）[HR = 5.6, P = 0.03] 是复发的预测因素。排除 AFP > 600 ng/mL 后，T2、T3 和 T4a 期肝癌的 5 年无复发生存率分别为 94%、86% 和 92%（P = 0.3）。T2 期和 T3 期肝癌的微血管侵犯率分别为 24.3% 和 53.6%（P = 0.005），T2 期和 T4a 期肝癌的微血管侵犯率分别为 24.3% 和 36.7%（P = 0.2）。总体而言，26 例（19.4%）患者术前影像学分期过高，23 例（17.1%）患者术前影像学分期过低。术前和组织病理学分期相同的患者 5 年无复发生存率分别为 94%、87% 和 94%（P = 0.6）。只要 AFP < 600 ng/mL，未进行过 DS 的 LDLT 治疗 UNOS T2、T3 和 T4a 期肝癌的生存率相当。