Prospective Validation of Ab Initio Liver Transplantation in Hepatocellular Carcinoma Upon Detection of Risk Factors for Recurrence After Resection
Prospective Validation of Ab Initio Liver Transplantation in Hepatocellular Carcinoma Upon Detection of Risk Factors for Recurrence After Resection
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DOI：
10.1002/hep.28339
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发表时间：
2016-03-01
期刊：
影响因子：
13.5
通讯作者：
Fuster, Josep
中科院分区：
文献类型：
--
作者：
Ferrer-Fabrega, Joana;Forner, Alejandro;Fuster, Josep
十年前，我们建议招募那些病理上有不良组织学标志(微血管侵犯和/或卫星；从头开始指示)的切除肝细胞癌患者进行移植，而不是等待复发的出现。这项研究评估了这种方法的结果。1995~2012年间，164例肝细胞癌患者接受了手术切除。85名患者是潜在的肝移植候选者，在检测到贬损的组织学标志物后被考虑进行肝移植。对没有这些标志物的患者进行了跟踪，在出现肿瘤复发/肝功能损害时考虑进行挽救肝移植。37例患者在病理上处于高危状态，48例处于低危状态。37名高危患者中有23人在随访期间复发，但其中9人的肿瘤负担程度禁止肝移植。其中17例最终移植成功，其中10例在影像/移植部位出现复发。术后中位随访50.9个月，2例肝细胞癌复发，5例死亡，5年生存率为82.4%。48名低危患者中有26人复发，其中11人接受了移植。术后中位随访59个月，2例复发，5例死亡，5年生存率为81.8%。结论：肝细胞癌术后复发高危患者在复发前征召入伍似乎是一种有效的策略，并与良好的长期结果相关；
A decade ago we proposed to enlist for transplantation those patients with resected hepatocellular carcinoma in whom pathology registered pejorative histological markers (microvascular invasion and/or satellites; ab initio indication) and not wait for the appearance of recurrence. This study evaluates the outcome of this approach. From 1995 to 2012, 164 patients with hepatocellular carcinoma underwent resection. Eighty-five patients were potential candidates for liver transplantation and were considered for it upon detection of pejorative histological markers. Patients without these markers were followed, and salvage liver transplantation was considered upon development of tumor recurrence/liver function impairment. Thirty-seven patients were at high risk and 48 at low risk of recurrence at pathology. Twenty-three out of 37 high-risk patients recurred during follow-up, but in nine of them the tumor burden extent contraindicated liver transplantation. Seventeen were finally transplanted: 10 of them presented recurrence at imaging/explant. After a median posttransplant follow-up of 50.9 months, hepatocellular carcinoma had recurred in two patients and five patients had died, the 5-year survival being 82.4%. Twenty-six of the 48 low-risk patients developed recurrence, and 11 of them were transplanted. After a median posttransplant follow-up of 59 months, two patients developed recurrence and five died, their 5-year survival being 81.8%. Conclusion: Enlistment of patients at high risk of HCC recurrence after resection but before recurrence development seems a valid strategy and is associated with excellent long-term outcome; as early (