Liver transplantation for hepatocellular carcinoma: A proposal of a prognostic scoring system
Liver transplantation for hepatocellular carcinoma: A proposal of a prognostic scoring system
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DOI：
10.1016/s1072-7515(00)00688-8
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发表时间：
2000-10-01
影响因子：
5.2
通讯作者：
Starzl, TE
中科院分区：
文献类型：
--
作者：
Iwatsuki, S;Dvorchik, I;Starzl, TE
背景：目前由国际抗癌联盟和美国癌症联合委员会建立的肝细胞癌分期系统并不一定能预测肝切除或肝移植后的预后。研究设计：对344例连续接受肝移植的非纤维板层性肝细胞癌患者进行肿瘤复发的各种临床和病理危险因素的检测，建立可靠的风险评分系统。结果：多因素分析确定了三个独立的显著不良预后因素：1)双叶分布的肿瘤，2)最大肿瘤的大小（2 ~ 5cm和bbb5cm）， 3)血管侵犯（微观和宏观）。根据多因素分析的相对危险度计算每位患者的预后危险评分（PRS）。根据肿瘤复发风险将患者分为5个级别：1级：PRS=0 ~ 11.0 ~ 15.0；4级：PRS大于等于15.0；5级：淋巴结、转移或边缘阳性。拟议的PRS系统与肝移植后无瘤生存率（5年1至5级分别为100%，61%,40%，5%和0%）相关性非常好，但目前的pTNM分期没有。结论：1)1级和2级患者接受肝移植治疗有效，2)4级和5级患者不适合肝移植，3)1级患者不能从辅助化疗中获益。[J]中华外科杂志，2000;31:389- 394。(C) 2000年由美国外科医师学会发布)。
Background: The current staging system of hepatocellular carcinoma established by the International Union Against Cancer and the American Joint Committee on Cancer does not necessarily predict the outcomes after hepatic resection or transplantation.Study Design: Various clinical and pathologic risk factors for tumor recurrence were examined on 344 consecutive patients who received hepatic transplantation in the presence of nonfibrolamellar hepatocellular carcinoma to establish a reliable risk scoring system.Results: Multivariate analysis identified three factors as independently significant poor prognosticators: 1) bilobarly distributed tumors, 2) size of the greatest tumor (2 to 5 cm and > 5 cm), and 3) vascular invasion (microscopic and macroscopic). Prognostic risk score (PRS) of each patient was calculated from the relative risks of multivariate analysis. The patients were grouped into five grades of tumor recurrence risk: grade 1: PRS=0 to 11.0 to 15.0; grade 4: PRS greater than or equal to 15.0; and grade 5: positive node, metastasis, or margin. The proposed PRS system correlated extremely well with tumor-free survival after liver transplantation (100%, 61%, 40%, 5%, and 0%, from grades 1 to 5, respectively, at 5 years), but current pTNM staging did not.Conclusions: 1) Patients with grades 1 and 2 are effectively treated with liver transplantation, 2) patients with grades 4 and 5 are poor candidates for liver transplantation, and 3) patients with grade 1 do not benefit from adjuvant chemotherapy. (J Am Coll Surg 2000; 131:389-334. (C) 2000 by the American College of Surgeons).