Hepatocellular Carcinoma Patients Are Advantaged in the Current Liver Transplant Allocation System
Hepatocellular Carcinoma Patients Are Advantaged in the Current Liver Transplant Allocation System
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DOI：
10.1111/j.1600-6143.2010.03127.x
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发表时间：
2010-07-01
影响因子：
8.8
通讯作者：
Freeman, R. B.
中科院分区：
文献类型：
--
作者：
Washburn, K.;Edwards, E.;Freeman, R. B.
符合米兰标准的肝细胞癌（HCC）患者在肝移植等待名单（WL）上获得优先权，并与非HCC患者竞争。从WL中退出是一种间接的移植访问措施。既往未报告HCC和非HCC患者脱落的竞争风险（CR）评价。纳入了2005年3月16日至2008年6月30日期间列出的患者。使用CR技术以及至脱落时间的考克斯模型估计脱落概率。总体而言，非HCC患者的WL退出率高于HCC患者（p < 0.0001）。这在所有地区都是可重复的。在考克斯回归分析中，肿瘤大小、终末期肝病模型（MELD）评分和甲胎蛋白（AFP）与脱落风险增加相关。CR多因素分析显示MELD评分和AFP是预测HCC患者退出的最有影响力的指标。预测脱落与CR的一致性指数为0.70。HCC患者似乎在目前的分配方案中被排除在外，这是基于较低的脱落率，而不考虑地理因素。结合MELD、AFP和肿瘤大小的连续评分可能有助于优先考虑HCC患者，以更好地将脱落率与非HCC患者等同起来，并使获得机会均等。
Patients with hepatocellular carcinoma (HCC) within Milan criteria receive priority on the liver transplant waiting list (WL) and compete with non-HCC patients. Dropout from the WL is an indirect measure of transplant access. Competing risks (CR) evaluation of dropout for HCC and non-HCC patients has not previously been reported. Patients listed between 16 March 2005 and 30 June 2008 were included. Probability of dropout was estimated using a CR technique as well as a Cox model for time to dropout. Overall, non-HCC patients had a higher dropout rate from the WL than HCC patients (p < 0.0001). This was reproducible throughout all regions. In Cox regression, tumor size, model for end-stage liver disease (MELD) score and alpha fetoprotein (AFP) were associated with increased dropout risk. Multivariable analysis with CR showed that MELD score and AFP, were most influential in predicting dropout for HCC patients. The index of concordance for predicting dropout with the CR was 0.70. HCC patients appear to be advantaged in the current allocation scheme based on lower dropout rates without regard to geography. A continuous score incorporating MELD, AFP and tumor size may help to prioritize HCC patients to better equate dropout rates with non-HCC patients and equalize access.