Recurrence of hepatocellular carcinoma after liver transplantation: Is there a place for resection?
Recurrence of hepatocellular carcinoma after liver transplantation: Is there a place for resection?
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DOI：
10.1002/lt.24742
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发表时间：
2017-04-01
影响因子：
4.6
通讯作者：
Adam, Rene
中科院分区：
文献类型：
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作者：
Fernandez-Sevilla, Elena;Allard, Marc-Antoine;Adam, Rene
肝细胞癌（HCC）在肝移植（LT）后的复发被广泛认为是一种终末期疾病。因此，在这种情况下，手术的作用是不确定的。本研究的目的是确定肝移植后肝癌复发后生存的预后因素，并评估手术在这种情况下的影响。本研究纳入了1991年至2013年期间在一家机构接受HCC移植并进一步发生LT后复发的所有患者。进行单因素和多因素分析，以确定影响复发后生存的因素。在493例肝细胞癌移植患者中，共有70例（14.2%）连续患者在中位无病期17个月后复发。复发后的中位生存期（MS）为19个月，复发后3年生存率为26%。大多数复发位于肝外（肺、淋巴结和骨; n=51; 72.9%），而仅在2例（2.8%）患者中观察到肝内复发。17例（24.3%）肝内和肝外均发现。共有22例（31.4%）患者接受了复发（肝内[n=2]和肝外[n=20]）的肉眼完全切除。移植后切除患者的MS为35个月，而非切除患者为15个月（复发时P100 ng/mL（风险比[HR]，2.1; 95%置信区间[CI]，1.1-4.1; P=0.03），肝内位置（HR，1.8; 95% CI，1.0-3.2; P=0.05）和多灶性复发（HR，1.8; 95% CI，1.1-3.1; P=0.04）。包括手术在内的治疗（HR，0.4; 95%CI，0.2-0.7; P=0.004）被确定为独立的有利因素。总之，肝移植后肝癌复发与预后不良有关。然而，切除与生存率的提高有关，因此在可行时应予以考虑。肝移植23 440-447 2017 AASLD。
Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is widely considered as a terminal condition. Therefore, the role of surgery is uncertain in this case. The purpose of this study was to identify the prognostic factors of survival after post-LT HCC recurrence and to evaluate the impact of surgery in this setting. All patients transplanted for HCC between 1991 and 2013 in a single institution and who further developed a post-LT recurrence were included in this study. Univariate and multivariate analyses were performed to identify factors affecting postrecurrence survival. Of the 493 patients transplanted for HCC, a total of 70 (14.2%) consecutive patients developed a recurrence after a median disease-free interval of 17 months. Median survival (MS) from the time of recurrence was 19 months, with a 3-year postrecurrence survival of 26%. Most recurrences were extrahepatic (lung, lymph node, and bone; n=51; 72.9%), whereas only intrahepatic recurrences were observed in 2 (2.8%) patients. Both intrahepatic and extrahepatic locations were found in 17 (24.3%) patients. A total of 22 (31.4%) patients underwent macroscopically complete resection of the recurrence (intrahepatic [n=2] and extrahepatic [n=20]). The MS for resected patients after transplantation was 35 months compared with 15 months for nonresected patients (P100ng/mL at relapse (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.1-4.1; P=0.03), intrahepatic location (HR, 1.8; 95% CI, 1.0-3.2; P=0.05), and multifocal recurrence (HR, 1.8; 95% CI, 1.1-3.1; P=0.04). The management including surgery (HR, 0.4; 95% CI, 0.2-0.7; P=0.004) was identified as an independent favorable factor. In conclusion, recurrence of HCC after LT is associated with a poor prognosis. However, resection is associated with improved survival and should therefore be considered when feasible. Liver Transplantation 23 440-447 2017 AASLD.