Liver transplantation and cirrhotomimetic hepatocellular carcinoma: classification and outcomes.
Liver transplantation and cirrhotomimetic hepatocellular carcinoma: classification and outcomes.
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DOI：
10.1002/lt.23876
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发表时间：
2014-07
影响因子：
4.6
通讯作者：
Levine, Matthew H.
中科院分区：
文献类型：
--
作者：
Clayton, Erica F.;Malik, Saloni;Bonnel, Alexander;Mu, Yifei;Olthoff, Kim;Shaked, Abraham;Abt, Peter L.;Peterman, Heather;Reddy, K. Rajender;Ottmann, Shane;Furth, Emma E.;Levine, Matthew H.
肝移植已成为肝硬化患者的肝细胞癌（HCC）的标准治疗方法，这些肝癌的大小和数字标准均符合福尔斯的要求。拟肝硬化型肝细胞癌是一种罕见的生长方式，其实质为浸润性肝实质，可变得广泛，并且可通过放射学研究逃避检测。这种类型的HCC的肝移植结果没有很好的报道，但通常被认为是差的。我们希望更好地描述这种变异的肝癌在移植肝脏，推导出这种肿瘤类型的分类系统，并评估这种肿瘤变异的肝移植的结果。回顾性分析了1996-2009年在一家HCC中心接受移植的所有患者（358例患者），确定了一系列26例表现出CMM生长模式的患者。我们为这种肿瘤生长模式变体开发了一种分类系统，并确定了患者和肿瘤特异性结局。我们根据肿瘤范围和细胞组织病理学推导出CMM HCC的分类方案，其中透明细胞病理学与良好的结局相关。我们注意到，肿瘤局限于一个肺叶的透明细胞病理学患者移植后3年和5年无复发生存率分别为100%和58.3%，而不符合这些标准的患者3年和5年无复发生存率为16.2%。我们中心7%的肝细胞癌移植患者具有拟肝硬化特征，透明细胞组织学和生长累及不到50%肝脏的患者预后良好。
Liver transplantation has become the standard of care treatment for hepatocellular carcinoma (HCC) that falls within size and numeric criteria in cirrhotic patients. Cirrhotomimetic (CMM) hepatocellular carcinoma is an uncommon growth pattern that infiltrates cirrhotic parenchyma, can become extensive in size, and can evade detection via radiologic studies. Liver transplant outcomes for this type of HCC is not well reported but generally considered to be poor. We wished to better describe this variant of HCC in explanted livers, derive a classification system for this tumor type, and assess the outcomes of liver transplantation for this tumor variant. Upon retrospective analysis of all patients transplanted at a single center for HCC in 1996–2009 (358 patients) a series of 26 patients exhibiting CMM growth pattern were identified. We developed a classification system for this tumor growth pattern variant and determined patient and tumor-specific outcomes. We derived a classification schema of CMM HCC based upon tumor extent and cellular histopathology with clear cell pathology being associated with favorable outcome. We note a 100% 3-year and 58.3% 5-year recurrence free survival after transplant in those with tumor confined to one lobe who have clear cell pathology versus 16.2% 3- and 5-year recurrence free survival in those who do not meet these criteria. Cirrhotomimetic HCC features are noted in 7% of patients transplanted for HCC in our center with favorable outcomes inpatients with clear cell histology and growth involving less than 50% of the liver.
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