Selection criteria for liver transplantation in early-stage hepatocellular carcinoma with cirrhosis:: Results of a multicenter study
Selection criteria for liver transplantation in early-stage hepatocellular carcinoma with cirrhosis:: Results of a multicenter study
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DOI：
10.1053/jlts.2001.27856
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发表时间：
2001-10-01
影响因子：
4.6
通讯作者：
Santoyo, J
中科院分区：
文献类型：
--
作者：
Figueras, J;Ibañez, L;Santoyo, J
原位肝移植（奥尔特）为肝细胞癌（HCC）和肝硬化患者提供了消除肿瘤和肝脏疾病的唯一机会。然而，在等待名单上的肿瘤进展和奥尔特后的复发是常见的。我们进行了一项大型多中心研究，以评估生存率和奥尔特后复发的相关因素。这项回顾性研究分析了1990年至1997年在西班牙8个中心接受奥尔特治疗的307例连续HCC和肝硬化患者的数据。奥尔特仅适用于小的（< 5 cm）局部肿瘤。奥尔特后5年生存率为63%，无病生存率为58%，复发率为21%。肿瘤直径大于5 cm与其他肿瘤特征相关，这些特征是预后不良的重要指标（无包膜、3个或更多结节、双叶、卫星结节和血管浸润）。然而，在多变量分析中，甲胎蛋白（AFP）水平大于300 ng/mL（P = 0.04; P = 0.02）和肉眼可见的血管浸润（P = 0.01; P = 0.0001）分别是与死亡率和复发独立相关的唯一因素。原位肝奥尔特适用于AFP水平较低且无肉眼血管侵犯或肝外疾病的小型肝癌患者。通过提高我们术前肿瘤成像的能力，我们将在奥尔特前更好地选择HCC患者。
Orthotopic liver transplantation (OLT) offers the only chance to eliminate both tumor and liver disease in patients with hepatocellular carcinoma (HCC) and cirrhosis. However, tumor progression while on the waiting list and recurrence after OLT are frequent. We undertook a large multicenter study to assess survival and related factors of recurrence after OLT. This retrospective study analyses data from 307 consecutive patients with HCC, and cirrhosis treated with OLT between 1990 and 1997 in eight centers in Spain. OLT was indicated only for small (< 5 cm) localized tumors. Five-year rates after OLT were 63% for survival, 58% for disease-free survival, and 21 % for recurrence. Tumor diameter larger than 5 cm was associated with other tumor characteristics that were significant indicators of poor outcome (absence of capsule, three or more nodules, bilobularity, satellite nodules, and vascular invasion). However, in multivariate analysis, alpha fetoprotein (AFP) levels greater than 300 ng/mL, (P = .04; P = .02) and macroscopic vascular invasion (P = .01; P = .0001) were the only factors independently associated with mortality and recurrence, respectively. OLT is indicated in patients with small HCCs who have low AFP levels and no macroscopic vascular invasion or extrahepatic disease. By increasing our ability for preoperative tumor imaging, we will achieve better selection of patients with HCC before OLT.