Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis
Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis
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DOI：
10.1053/jhep.2001.23561
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发表时间：
2001-05-01
期刊：
影响因子：
13.5
通讯作者：
Neuhaus, P
中科院分区：
文献类型：
--
作者：
Jonas, S;Bechstein, WO;Neuhaus, P
肝硬化合并肝细胞癌（HCC）患者的肝移植选择遵循肿瘤结节数量和直径的限制。尚未研究这些参数与血管浸润是否相关。从1989年到2000年，在1,087名患者中进行了1,188次肝移植，其中包括120名（11%）肝硬化HCC患者。选择标准是最大直径不超过5 cm（如果肿瘤呈单结节）或不超过3 cm（如果有2或3个结节）。术后死亡率为1.7%。1年、5年和10年生存率分别为90%、71%和60%。在940例无HCC的移植患者中，这些比率分别为93%、87%和83%（P <0.0001）。多因素分析确定血管浸润和组织病理学分级为预后参数。在逻辑回归分析中，组织病理学分级和最大直径显示与血管浸润显著相关。分析大于5 cm的肿瘤，即，由于诊断不准确或进展而不符合选择标准的肿瘤，与中分化和低分化肿瘤（100%）相比，高分化肿瘤（25%）患者的血管浸润率显著（P <0.01）低。肝移植是一种安全有效的长期治疗小肝癌的方法。肝硬化中的HCC。肿瘤直径和结节数量与组织病理学分级相关，仅在大于5 cm的HCC中预测血管浸润。
Selection of patients suffering from hepatocellular carcinoma (HCC) in cirrhosis for liver transplantation follows limits of number and diameter of tumor nodules. It has not been investigated whether there is a correlation of these parameters with vascular invasion. From 1989 to 2000, 1,188 liver transplantations were performed in 1,087 patients, including 120 patients (11%) with an HCC in cirrhosis. Selection criteria were a maximal diameter of up to 5 cm if the tumor appeared to be uninodular or of up to 3 cm in the case of 2 or 3 nodules. The postoperative mortality rate was 1.7%. One-, 5-, and 10-year survival was 90%, 71%, and 60%, respectively. In 940 transplantation patients without an HCC, these rates were 93%, 87%, and 83% (P < .0001). Vascular invasion and histopathologic grading were identified as prognostic parameters by multivariate analysis. In a logistic regression analysis, histopathologic grading and maximal diameter showed a significant correlation with a vascular invasion. Analyzing tumors larger than 5 cm, i.e., tumors not fulfilling the selection criteria as a result of diagnostic inaccuracy or progression thereafter, the rates of vascular invasion were significantly (P < .01) lower in patients suffering from well-differentiated tumors (25%) when compared with moderately and poorly differentiated tumors (100%). Liver transplantation is a safe and effective longterm treatment for small. HCC in cirrhosis. Tumor diameter and number of nodules in correlation with the histopathologic grading were predictive of a vascular invasion only in HCC larger than 5 cm.