Kim Jiyoung, Hong Suk Kyun, Kim Jae-Yoon, Lee Jaewon, Choi Hyun Hwa, Lee Sola, Hong Su Young, Lee Jeong-Moo, Choi YoungRok, Yi Nam-Joon, Lee Kwang-Woong, Suh Kyung-Suk
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2023 Jul;105(1):47-56. doi: 10.4174/astr.2023.105.1.47. Epub 2023 Jul 4.
Total necrosis of hepatocellular carcinoma (HCC) achieved via locoregional treatment (LRT) is considered to indicate a lack of tumor viability. Nonetheless, there is insufficient evidence of recurrence after liver transplantation (LT) in patients with such a status. The aim of this study was to investigate the prognosis of patients diagnosed with totally necrotic nodules upon explant hepatectomy after LT.
We conducted a retrospective study of patients diagnosed with totally necrotic nodules after LT for HCC. A total of 165 patients with HCC who underwent living- or deceased-donor LT from 2000 to 2020 in our hospital were included.
A total of 5 patients (3.0%) exhibited HCC recurrence during a median follow-up of 84 months (range, 4-243 months) after LT. The 5-year overall and recurrence-free survival rates of these patients were 92.8% and 92.2%, respectively. Four patients in the HCC-recurrence group (80.0%) died even after further treatment, including transarterial chemoembolization, surgery, and systemic treatment. Both univariate and multivariate analyses of clinicopathological factors identified a maximum diameter of the totally necrotic nodules of >5 cm as the only factor associated with tumor recurrence following LT (P = 0.005 and P = 0.009, respectively).
Total necrosis of HCC via LRT yielded excellent survival outcomes for patients undergoing LT. Nevertheless, patients with large tumors should be considered at high risk of recurrence after LT, suggesting the need for their active surveillance during the follow-up period.
通过局部区域治疗（LRT）实现的肝细胞癌（HCC）完全坏死被认为表明肿瘤缺乏活性。尽管如此，对于处于这种状态的患者肝移植（LT）后复发的证据仍不足。本研究的目的是调查LT后肝切除标本中诊断为完全坏死结节的患者的预后。
我们对LT治疗HCC后诊断为完全坏死结节的患者进行了一项回顾性研究。纳入了2000年至2020年在我院接受活体或尸体供体LT的165例HCC患者。
在LT后的中位随访84个月（范围4 - 243个月）期间，共有5例患者（3.0%）出现HCC复发。这些患者的5年总生存率和无复发生存率分别为92.8%和92.2%。HCC复发组的4例患者（80.0%）即使在接受进一步治疗（包括经动脉化疗栓塞、手术和全身治疗）后仍死亡。对临床病理因素的单因素和多因素分析均确定完全坏死结节的最大直径>5 cm是与LT后肿瘤复发相关的唯一因素（分别为P = 0.005和P = 0.009）。
通过LRT实现的HCC完全坏死为接受LT的患者带来了良好的生存结果。然而，大肿瘤患者应被视为LT后复发的高风险患者，这表明在随访期间需要对其进行积极监测。
