Vitale Alessandro, Brolese Marco, Govoni Ilaria, Naldini Chiara, Canitano Nicola, Gringeri Enrico, D'Amico Francesco, Bassi Domenico, D'Amico Francesco Enrico, Lanari Jacopo, Furlanetto Alessandro, Padoan Virginia, Salinas Daniel, Cillo Umberto
Unità di Chirurgia Epatobiliopancreatica e Trapianto Epatico, Azienda Ospedaliera-Università di Padova, 35128 Padova, Italy.
Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica (DiMePRe-J), Bari University, 70121 Bari, Italy.
Cancers (Basel). 2025 Jul 4;17(13):2248. doi: 10.3390/cancers17132248.
: Salvage liver transplantation (SLT) is a well-established option for hepatocellular carcinoma (HCC) recurrence after liver resection. Laparoscopic microwave ablation (L-MWA) represents another curative strategy for early-stage HCC. However, its role within this therapeutic framework remains unexplored. : Between 2014 and 2023, we treated 1341 patients with HCC using L-MWA. From this cohort, patients with Child-Pugh class A liver function, HCC within the Milan criteria, no contraindications to transplantation, and ≥12 months of follow-up were selected. SLT failure was defined as non-transplantable recurrence or death, resulting in the loss of a potentially curative therapeutic opportunity. The primary endpoint was overall survival (OS); secondary endpoints included predictors of survival and SLT failure. A total of 341 patients met the inclusion criteria. Five-year OS was 62%. Independent predictors of poorer survival included the presence of cardiac disease or oesophageal varices, a Child-Pugh score of 6, tumour size, and elevated alpha-fetoprotein (AFP) levels. Treatment was successful in 255 patients (74.8%): 102 (29.9%) underwent SLT, 67 (19.6%) received alternative therapies, and 93 (27.3%) remained recurrence-free. Treatment failure occurred in 86 patients (25.2%) due to non-transplantable recurrence or death. Independent predictors of failure included older age, non-HBV aetiology, and elevated AFP levels. Five-year OS rates were 79% in the success group and 22% in the failure group ( < 0.001). : A combined L-MWA and SLT strategy is safe and effective, yielding a 62% 5-year OS rate. This approach supports more efficient graft use with a consequent increase in the population transplant benefit. Improved selection may further reduce failure rates.
挽救性肝移植（SLT）是肝切除术后肝细胞癌（HCC）复发的一种成熟治疗选择。腹腔镜微波消融（L-MWA）是早期HCC的另一种根治性治疗策略。然而，其在这一治疗框架中的作用仍未得到探索。2014年至2023年期间，我们使用L-MWA治疗了1341例HCC患者。从该队列中，选择肝功能为Child-Pugh A级、HCC符合米兰标准、无移植禁忌且随访时间≥12个月的患者。SLT失败定义为不可移植的复发或死亡，导致失去潜在治愈性治疗机会。主要终点是总生存期（OS）；次要终点包括生存预测因素和SLT失败。共有341例患者符合纳入标准。5年总生存率为62%。生存较差的独立预测因素包括存在心脏病或食管静脉曲张、Child-Pugh评分为6分、肿瘤大小以及甲胎蛋白（AFP）水平升高。255例患者（74.8%）治疗成功：102例（29.9%）接受了SLT，67例（19.6%）接受了替代治疗，93例（27.3%）无复发。86例患者（25.2%）因不可移植的复发或死亡而治疗失败。失败的独立预测因素包括年龄较大、非乙肝病因以及AFP水平升高。成功组的5年总生存率为79%，失败组为22%（P<0.001）。L-MWA和SLT联合策略安全有效，5年总生存率为62%。这种方法支持更有效地使用移植物，从而增加人群移植受益。改进选择可能会进一步降低失败率。
