Recurrence of hepatocellular carcinoma after liver transplant: Patterns and prognosis
Recurrence of hepatocellular carcinoma after liver transplant: Patterns and prognosis
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DOI：
10.1002/lt.20128
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发表时间：
2004-04-01
影响因子：
4.6
通讯作者：
Schwartz, ME
中科院分区：
文献类型：
--
作者：
Roayaie, S;Schwartz, JD;Schwartz, ME
人们对肝细胞癌（HCC）肝移植后复发的自然史、治疗效果和生存率知之甚少。对1988年9月19日至2002年9月19日接受肝移植的所有成人患者进行了回顾性分析。只有组织学证实的肝细胞癌患者的移植物，随后发展复发被纳入进一步的分析。分析的终点是移植后的生存率和复发后的生存率。分析了患者的人口统计学和实验室检查值、移植技术（整尸、分割或活体供体）和肿瘤特征。复发的时间、位置以及任何药物或手术治疗也被考虑在内。在311例取出的HCC患者中，57例（18.3%）最终被诊断为移植后复发肿瘤。中位复发时间为12.3。复发患者的5年生存率（22%）显著低于未复发患者（64%）（P < 0.0001）。多变量分析表明，原发肿瘤的大小和分化程度以及骨复发的存在与复发患者的移植存活率独立相关。当对复发后的生存率进行分析时，多变量分析显示，无骨转移、移植后12个月以上复发和复发的手术治疗与显著延长的生存率独立相关。总之，肝细胞癌的复发显著缩短了移植后的生存期。尽管如此，一些复发的患者预计可以活相当长的一段时间。复发性疾病应尽可能手术治疗，因为手术与更长的生存期独立相关。
Very little is known about the natural history, effects of therapy, and survival after recurrence of hepatocellular carcinoma (HCC) after liver transplantation. All adult patients undergoing liver transplant from September 19, 1988, until September 19, 2002, were reviewed. Only patients with histologically proven HCC in the explant who subsequently developed recurrence were included in further analysis. The endpoints analyzed were survival from time of transplant and survival from time of recurrence. Recipient demographics and laboratory values, technique of transplant (whole cadaver, split, or living donor), and tumor characteristics were analyzed. The time to, location of, and any medical or surgical treatment of recurrences also were considered. Of the 311 patients with HCC in the explant, 57 (18.3%) eventually were diagnosed with recurrent tumor after transplant. Median time to recurrence was 12.3. Five-year survival was significantly lower for patients with recurrence (22%) than for patients without recurrence (64%)(P < 0.0001). Multivariate analysis demonstrated that the size and differentiation of the original tumor, as well as the presence of bone recurrence, were independently associated with survival from transplant in patients with recurrence. When survival from the time of recurrence was analyzed, multivariate analysis showed that the absence of bone metastases, recurrence more than 12 months from transplant, and surgical treatment of the recurrence were independently associated with significantly longer survival. In conclusion, recurrence of HCC significantly shortens survival after transplant. Nonetheless, some patients with recurrence can be expected to live for a considerable period of time. Recurrent disease should be treated surgically when possible, because surgery is independently associated with longer survival.