Liver Transplantation and Hepatic Resection can Achieve Cure for Hepatocellular Carcinoma
Liver Transplantation and Hepatic Resection can Achieve Cure for Hepatocellular Carcinoma
复制标题
DOI：
10.1097/sla.0000000000002889
复制
发表时间：
2018-11-01
影响因子：
9
通讯作者：
Cucchetti, Alessandro
中科院分区：
文献类型：
--
作者：
Pinna, Antonio Daniele;Yang, Tian;Cucchetti, Alessandro
目的：本研究的目的是估计概率达到统计治愈肝细胞癌（HCC）与肝切除术（HR）和肝移植（LT）。背景：统计治愈发生时，特定人群的死亡率返回值的一般人群。切除和移植被认为是潜在的根治性治疗肝癌，但其对剩余的整个寿命的影响从来没有被investigated.Methods：数据从3286肝癌患者接受LT（n = 1218）或HR（n = 2068）被用来估计统计治愈。无病生存期（DFS）是通过非混合模型估计治愈分数的主要生存指标。总生存期（OS）是次要指标。在这两项研究中，患者均按年龄、性别、年龄和人种/种族与一般人群相匹配。结果：考虑DFS，LT后治愈率为74.1%，HR后治愈率为24.1%（效应量> 0.8）。在所有考虑的移植标准中，LT优于HR（效应量> 0.8），特别是对于多发性肿瘤（> 0.9），甚至在脱落率高达20%（> 0.5）的情况下。考虑到OS，LT后的治愈分数略微增加至75.8%，之后HR增加至40.5%。对于寡结节肿瘤，LT相对于HR在治愈方面的效果大小下降（
Objective: The aim of this study was to estimate probabilities of achieving the statistical cure from hepatocellular carcinoma (HCC) with hepatic resection (HR) and liver transplantation (LT).Background: Statistical cure occurs when the mortality of a specific population returns to values of that of general population. Resection and transplantation are considered potentially curative therapies for HCC, but their effect on the residual entire life-expectancy has never been investigated.Methods: Data from 3286 HCC patients treated with LT (n = 1218) or HR (n = 2068) were used to estimate statistical cure. Disease-free survival (DFS) was the primary survival measure to estimate cure fractions through a non-mixture model. Overall survival (OS) was a secondary measure. In both, patients were matched with general population by age, sex, year, and race/ethnicity. Cure variations after LT were also adjusted for different waiting-list drop-outs.Results: Considering DFS, the cure fraction after LT was 74.1% and after HR was 24.1% (effect size >0.8). LT outperformed HR within all transplant criteria considered (effect size >0.8), especially for multiple tumors (>0.9) and even in presence of a drop-out up to 20% (>0.5). Considering OS, the cure fraction after LT marginally increased to 75.8%, and after that HR increased to 40.5%. The effect size of LT over HR in terms of cure decreased for oligonodular tumors (