Marsh J W, Dvorchik I, Subotin M, Balan V, Rakela J, Popechitelev E P, Subbotin V, Casavilla A, Carr B I, Fung J J, Iwatsuki S
Department of Surgery, University Health Center of Pittsburgh, University of Pittsburgh, PA, USA.
Hepatology. 1997 Aug;26(2):444-50. doi: 10.1002/hep.510260227.
Orthotopic liver transplantation (OLTx) in the presence of hepatocellular carcinoma (HCC) has been complicated by high recurrence rates. The ability to determine the risk and timing of HCC recurrence on an individual basis would greatly aid in the candidate selection process resulting in a more efficient use of donated organs and allow the individualization and better evaluation of adjuvant chemotherapy. The 214 patients who underwent OLTx in the presence of HCC were analyzed. From the 178 patients who survived more than 150 days, 71 (40%) have suffered HCC recurrence. Based on five risk factors, that is, gender, tumor number, lobar tumor distribution, tumor size, grade of vascular invasion, artificial neural network models predicting the likelihood of HCC recurrence within 1, 2, and 3 consecutive years after transplantation were developed. Based on model predictions, those combinations of risk factors that should/should not lead to recurrence were generated, allowing stratification of patients into the following three groups: 1) patients who should not suffer HCC recurrence and who should not need adjuvant therapy, 2) patients who will suffer recurrence and for whom postoperative chemotherapy significantly prolonged survival (but did not prevent recurrence), and 3) patients who may or may not suffer HCC recurrence and whose recurrence may be prevented by adjuvant chemotherapy. The outcome of OLTx for patients with HCC can be prognosticated based on a number of clinical variables. If verified through multicenter trials, these models could be made available to transplantation programs performing OLTx in the presence of HCC.
在肝细胞癌（HCC）存在的情况下进行原位肝移植（OLTx）一直存在高复发率的问题。能够根据个体情况确定HCC复发的风险和时间，将极大地有助于候选者的选择过程，从而更有效地利用捐赠器官，并实现辅助化疗的个体化和更好评估。对214例在HCC存在情况下接受OLTx的患者进行了分析。在178例存活超过150天的患者中，71例（40%）出现了HCC复发。基于性别、肿瘤数量、叶内肿瘤分布、肿瘤大小、血管侵犯分级这五个风险因素，开发了预测移植后连续1、2和3年内HCC复发可能性的人工神经网络模型。根据模型预测，生成了那些应该/不应该导致复发的风险因素组合，从而将患者分为以下三组：1）不应出现HCC复发且不需要辅助治疗的患者；2）将会复发且术后化疗显著延长生存期（但不能预防复发）的患者；3）可能出现或不出现HCC复发且其复发可通过辅助化疗预防的患者。HCC患者的OLTx结局可根据一些临床变量进行预测。如果通过多中心试验得到验证，这些模型可提供给在HCC存在情况下进行OLTx的移植项目。
