Bhatti Abu Bakar Hafeez, Dar Faisal Saud, Altaf Abdullah, Rana Atif, Nazer Rashid, Zia Haseeb Haider, Khan Nusrat Yar, Salih Mohammad, Shah Najmul Hassan, Khan Nasir Ayub
Department of Hepatobiliary Surgery and Liver Transplantation, Shifa International Hospital Islamabad, Islamabad, Pakistan; Shifa Tameer-e-Millat University, Islamabad, Pakistan.
Department of Hepatobiliary Surgery and Liver Transplantation, Shifa International Hospital Islamabad, Islamabad, Pakistan.
J Gastrointest Surg. 2024 Dec;28(12):2084-2089. doi: 10.1016/j.gassur.2024.10.008. Epub 2024 Oct 9.
New guidelines propose a minimum 5-year survival of 60% for hepatocellular carcinoma (HCC) with living donor liver transplantation (LDLT). This study aimed to evaluate the 5- and 10-year survival rates after transplantation for the expanded criteria for HCC.
This single-center retrospective cohort study included 208 patients who underwent LDLT for the expanded criteria (the largest tumor diameter of ≤10 cm, any tumor number, and alpha-fetoprotein [AFP] level of <1000 ng/mL) and analyzed 5- and 10-year overall survival (OS) and recurrence risk (RR) rates.
With a median follow-up of 65.1 months (IQR, 19.1-80.2), the 5- and 10-year OS and RR rates were 67.0% and 61.0% and 20.5% and 22.5%, respectively. The largest tumor diameter of >6 cm (hazard ratio [HR], 3.7; 95% CI, 1.7-8.2; P = .001) and AFP level of >400 ng/mL (HR, 4.0; 95% CI, 1.8-9.0; P = .001) were predictors of recurrence. Patients outside the Milan criteria (MC) were grouped into low- and high-risk HCC based on tumor size and AFP level. For low-risk HCC (tumor size of <6 cm, any tumor number, and AFP level of <400 ng/mL), the 5-year RR was comparable to the MC and increased the transplant pool by 35.7% (P > .5). The median number of tumors and the rate of microvascular invasion in the high-risk group, low-risk group, and MC were 2.0 (1.0-3.2), 4.0 (2.0-5.0), and 1.0 (1.0-2.0) (P < .001) and 72.2% (13/18), 44.0% (22/50), and 22.8% (32/140) (P < .001), respectively.
The expanded criteria met the benchmark for 5-year survival. LDLT for the low-risk HCC in the expanded criteria was associated with an acceptable RR.
新指南提出活体肝移植（LDLT）治疗肝细胞癌（HCC）的最低5年生存率为60%。本研究旨在评估扩大标准的HCC患者移植后的5年和10年生存率。
这项单中心回顾性队列研究纳入了208例因扩大标准（最大肿瘤直径≤10 cm、肿瘤数量不限、甲胎蛋白[AFP]水平<1000 ng/mL）接受LDLT的患者，并分析了5年和10年总生存率（OS）及复发风险（RR）率。
中位随访时间为65.1个月（四分位间距，19.1 - 80.2），5年和10年的OS率分别为67.0%和61.0%，RR率分别为20.5%和22.5%。最大肿瘤直径>6 cm（风险比[HR]，3.7；95%置信区间，1.7 - 8.2；P = 0.001）和AFP水平>400 ng/mL（HR，4.0；95%置信区间，1.8 - 9.0；P = 0.001）是复发的预测因素。米兰标准（MC）以外的患者根据肿瘤大小和AFP水平分为低风险和高风险HCC。对于低风险HCC（肿瘤大小<6 cm、肿瘤数量不限、AFP水平<400 ng/mL），5年RR与MC相当，且移植供体池增加了35.7%（P > 0.5）。高风险组、低风险组和MC组的肿瘤中位数及微血管侵犯率分别为2.0（1.0 - 3.2）、4.0（2.0 - 5.0）和1.0（1.0 - 2.0）（P < 0.001）以及72.2%（13/18）、44.0%（22/50）和22.8%（32/140）（P < 0.001）。
扩大标准达到了5年生存的基准。扩大标准中低风险HCC的LDLT与可接受的RR相关。
