Survival After Liver Transplantation for Hepatocellular Carcinoma in the Model for End-Stage Liver Disease and Pre-Model for End-Stage Liver Disease Eras and the Independent Impact of Hepatitis C Virus
Survival After Liver Transplantation for Hepatocellular Carcinoma in the Model for End-Stage Liver Disease and Pre-Model for End-Stage Liver Disease Eras and the Independent Impact of Hepatitis C Virus
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DOI：
10.1002/lt.21744
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发表时间：
2009-07-01
影响因子：
4.6
通讯作者：
Segev, Dorry L.
中科院分区：
文献类型：
--
作者：
Thuluvath, Paul J.;Maheshwari, Anurag;Segev, Dorry L.
有研究表明，丙型肝炎病毒（HCV）合并肝细胞癌（HCC）患者在肝移植（LT）后的预后可能更差，因为肿瘤生物学更具侵袭性。在这项研究中，我们使用联合器官共享网络（United Network for Organ Sharing）从1994年1月到2008年3月的数据，确定了伴有和不伴有HCV的HCC患者的肝移植后生存率。HCC患者被分为HCV组（HCC-HCV）和非HCV组（HCC-non-HCV）。在终末期肝病模型（MELD）之前的时代，有1237例HCC患者（780例，HCV； 373例，非HCV； 84例，HCV状态未知），在MELD时代，有4933例HCC患者（3272例，HCV； 1348例，非HCV； 313例，未知）。在meld前，hcc -非hcv患者的5年移植生存率（58.6%对53.7%）和患者生存率（61.7%对59.3%）略高于HCC-HCV患者。在MELD时代，hcc -非hcv患者的5年移植生存率（61.2%对55.5%）和患者生存率（63.7%对58.2%）略高于HCC-HCV患者。在没有HCC的患者中，MELD前和MELD时期非HCV患者的移植/患者生存率高于HCV患者。合并和不合并HCV的HCC患者的生存率差异低于按HCV状态分层的非HCC患者。HCV对HCC患者肝移植后生存没有额外的负面影响，多变量分析进一步证实了这一点。总之，HCC患者的生存率在过去20年没有变化。无论HCC状态如何，HCV患者的生存率低于非HCV患者，但HCV对HCC患者的生存率没有额外的负面影响。中华肝病杂志，2009。(c) 2009年。
It has been suggested that hepatitis C virus (HCV) patients with hepatocellular carcinoma (HCC) may have worse outcomes after liver transplantation (LT) because of more aggressive tumor biology. In this study, we determined the post-LT survival of HCC patients with and without HCV using United Network for Organ Sharing data from January 1994 to March 2008. Patients with HCC were stratified into HCV (HCC-HCV) and non-HCV (HCC-non-HCV) groups. In the era before the Model for End-Stage Liver Disease (MELD), there were 1237 HCC patients (780, HCV; 373, non-HCV; 84, unknown HCV status), and during the MELD era, there were 4933 HCC patients (3272, HCV; 1348, non-HCV; 313, unknown). In the pre-MELD era, 5-year graft (58.6% versus 53.7%) and patient (61.7% versus 59.3%) survival rates were marginally higher for HCC-non-HCV patients than for HCC-HCV patients. In the MELD era also, 5-year graft (61.2% versus 55.5%) and patient (63.7% versus 58.2%) survival rates were marginally higher for HCC-non-HCV patients than for HCC-HCV patients. In patients without HCC, pre-MELD and MELD era graft/patient survival rates for non-HCV patients were higher than those for HCV patients. The differences in survival rates for HCC patients with and without HCV were lower than those for non-HCC patients stratified by their HCV status. HCV had no additional negative impact on the post-LT survival of patients with HCC, and this was further confirmed by multivariate analysis. In conclusion, the survival of HCC patients has remained unchanged in the past 2 decades. HCV patients have a lower survival rate than non-HCV patients, regardless of their HCC status, but HCV has no additional negative impact on survival in patients with HCC. Liver Transpl 15:754-762, 2009. (C) 2009 AASLD.