High pathological risk of recurrence after surgical resection for hepatocellular carcinoma:: An indication for salvage liver transplantation
High pathological risk of recurrence after surgical resection for hepatocellular carcinoma:: An indication for salvage liver transplantation
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DOI：
10.1002/lt.20202
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发表时间：
2004-10-01
影响因子：
4.6
通讯作者：
Bruix, J
中科院分区：
文献类型：
--
作者：
Sala, M;Fuster, J;Bruix, J
手术切除和肝移植为肝细胞癌患者提供了超过70%的5年生存率，但高复发率损害了切除术后的长期结局。病理学数据，如血管浸润和检测到额外的结节预测复发，并将患者分为高风险和低风险。基于这一点，我们建议对那些病理学证明即使没有证实的残留疾病也有高复发风险的切除患者进行挽救性肝移植。从1995年1月至2003年8月，我们评估了1，638名患者。77例患者有切除指征，但只有17例（22%）（所有患者，14例丙型肝炎病毒阳性）是切除和移植的最佳候选人。其中8例在病理学上表现出高风险特征，并提供了移植。在8例高风险患者中，7例复发，而9例低风险患者中仅2例复发（P = 0.012）。两名高风险患者拒绝移植，并在随访期间发生多灶性疾病。其他6名患者入选，除我外，所有患者的取出物中均存在肿瘤病灶。只有我在移植后早期出现肝外播散，并在4个月后死亡。其他人在中位随访45个月后无疾病。在低风险患者中检测到2例复发，其中1例在术后18个月进行移植。这些数据在一个小系列的患者证实，病理参数确定患者复发的风险较高，这使得他们被列为肝移植没有被证实的恶性疾病。总之，该策略在临床上是有效的，并且可以进一步改善切除患者的结局。
Surgical resection and liver transplantation offer a 5-year survival greater than 70% in patients with hepatocellular carcinoma, but the high recurrence rate impairs long-term outcome after resection. Pathological data such as vascular invasion and detection of additional nodules predict recurrence and divide patients into high and low risk profile. Based on this, we proposed salvage liver transplant to resected patients in whom pathology evidenced high recurrence risk even in the absence of proven residual disease. From January 1995 to August 2003 we have evaluated 1,638 patients. Resection was indicated in 77 patients, but only 17 (22%) (all cirrhotics, 14 hepatitis C virus+) were optimal candidates for both resection and transplantation. Of them, 8 exhibited a high risk profile at pathology and were offered transplantation. Among the 8 high risk patients, 7 presented recurrence, compared with only 2 of the 9 at low risk (P = .012). Two of the high risk patients refused transplant and developed multifocal disease during follow-up. The other 6 were enlisted and all but I had tumor foci in the explant. Only I presented extrahepatic dissemination early after transplant and died 4 months later. The others are free of disease after a median follow-up of 45 months. Two recurrences were detected in low risk patients, I of them being transplanted 18 months after surgery. These data in a small series of patients confirm that pathological parameters identify patients at higher risk of recurrence, which allow them to be listed for liver transplantation without proven malignant disease. In conclusion, this policy is clinically effective and could further improve the outcome of resected patients.