Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, España.
Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal.
Rev Esp Enferm Dig. 2022 Apr;114(4):219-225. doi: 10.17235/reed.2021.7744/2020.
despite advances in imaging diagnostic modalities, hepatocellular carcinoma is sometimes incidentally diagnosed on histological examination of the liver explant. The objectives of the study were: a) to compare the characteristics between incidental and known hepatocellular carcinoma; and b) to estimate survival and tumor recurrence after liver transplantation.
a retrospective, single-center study was performed. The inclusion criteria were: a) cirrhotic patients, age ≥ 18 years; b) liver transplantation between 1998 and 2018; and c) hepatocellular carcinoma diagnosed via histopathologic examination of the explanted liver. Cholangiocarcinoma and patients with early retransplantation were excluded. Multivariate analysis was performed using binomial logistic regression to assess the factors associated with incidental hepatocellular carcinoma. Kaplan-Meier curves were plotted to explore the impact on overall survival and recurrence free survival.
two hundred and sixty-nine patients were enrolled. The prevalence of incidental hepatocellular carcinoma was 4.18 % (95 % CI: 2.89-6.01 %) of all liver transplants performed in cirrhotic patients. The median diameter of the main nodule was smaller in incidental hepatocellular carcinoma (20 vs 27 mm, p = 0.004), although they were more likely to be beyond the Up-to-Seven criteria on explant examination (22.2 % vs 7.5 %, p = 0.001), with no differences in any other histological features. No differences were found in overall survival rates (incidental 70.2 % vs 70.4 %, p = 0.87) or recurrence-free survival (incidental 100 % vs 83.8 %, p = 0.07) at five years.
incidental hepatocellular carcinoma are smaller in size and are more frequently found to be beyond the Up-to-Seven criteria. However, no differences were found in overall survival rates or recurrence-free survival, although there was no tumor recurrence in the incidental hepatocellular carcinoma group.
尽管影像学诊断方法不断进步，但有时仍会在肝脏移植的组织学检查中偶然诊断出肝细胞癌。本研究的目的是：a）比较偶然和已知的肝细胞癌的特征；b）估计肝移植后的生存和肿瘤复发。
进行了一项回顾性的单中心研究。纳入标准为：a）肝硬化患者，年龄≥18 岁；b）1998 年至 2018 年之间进行的肝移植；c）通过移植肝脏的组织病理学检查诊断为肝细胞癌。排除胆管癌和早期再移植患者。使用二项逻辑回归分析进行多变量分析，以评估与偶然肝细胞癌相关的因素。绘制 Kaplan-Meier 曲线以探讨对总体生存和无复发生存的影响。
共纳入 269 例患者。在所有肝硬化患者的肝移植中，偶然肝细胞癌的患病率为 4.18%（95%CI：2.89-6.01%）。偶然肝细胞癌的主结节的中位直径较小（20 毫米与 27 毫米，p=0.004），尽管它们在移植检查中更有可能超出 Up-to-Seven 标准（22.2%与 7.5%，p=0.001），但在任何其他组织学特征上无差异。在五年时，总体生存率（偶然组 70.2%与 70.4%，p=0.87）或无复发生存率（偶然组 100%与 83.8%，p=0.07）均无差异。
偶然肝细胞癌的直径较小，并且更常超出 Up-to-Seven 标准。然而，在总体生存率或无复发生存率方面无差异，尽管偶然肝细胞癌组未发现肿瘤复发。
