Liver transplantation for hepatocellular carcinoma: Is there evidence for expanding the selection criteria?
Liver transplantation for hepatocellular carcinoma: Is there evidence for expanding the selection criteria?
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DOI：
10.1097/01.tp.0000187107.64215.7b
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发表时间：
2005-09-27
期刊：
影响因子：
6.2
通讯作者：
Encke, J
中科院分区：
文献类型：
--
作者：
Sauer, P;Kraus, TW;Encke, J
在接受肝细胞癌(HCC)肝移植的患者中，随后应用米兰标准可能会导致极好的长期存活率和低复发率。扩大选择标准将导致更多的肝细胞癌患者得到潜在的根治性治疗，但这种方法至少与更高的复发率相关。Kaplan-Meier对1987-2004年间在我所接受肝移植治疗肝癌的110名患者的分析显示，随着时间的推移，患者的存活率有了显著的提高。患者选择标准的改变可能有助于改善结果。110例患者中有28例观察到肝细胞癌复发。在发生癌症复发的患者中，82%的患者没有达到米兰标准。从等待名单上退出是很常见的，几种方法，包括经皮乙醇注射、射频消融和化疗栓塞术，被用来防止肿瘤进展，从而防止退出。由于没有随机试验可用，这些新辅助手术是否能改善结果仍存在一些不确定性。目前，没有证据表明这种方法可以扩大遴选标准。肝细胞癌是活体亲属肝移植的主要适应症，因为等待期间辍学的风险可以忽略不计。延长米兰活体肝移植标准可能会为更多的患者提供一种潜在的根治疗法，而不会减少等待名单上的其他非恶性肝病患者的器官捐赠池。
A consequent application of the Milan criteria in patients undergoing liver transplantation for hepatocellular carcinoma (HCC) may lead to excellent long-term survival and a low incidence of recurrence. Expanding the selection criteria will result in more patients with hepatocellular carcinoma being potentially curative treated, but this approach is associated with at least a higher incidence of recurrence. Kaplan-Meier analysis of 110 patients, who underwent liver transplantation for HCC in our institution between 1987 and 2004, showed a significant improvement in patient survival with time. A change in criteria for patient selection may have contributed to the improved outcome. In 28 of 110 patients a recurrence of HCC was observed. In 82% of patients, who developed recurrence of carcinoma, the Milan criteria were not met. Dropout from the waiting list is common and several methods, including percutaneous ethanol injection, radiofrequency ablation, and chemoembolization, are used to prevent tumor progression and thus prevent dropout. As no randomized trials are available some uncertainty remains, whether these neoadjuvant procedures improve outcome. At present, there is no evidence that this approach enables expansion of the selection criteria. Hepatocellular carcinoma is a major indication for living related liver transplantation because the risk of dropout while waiting is negligible. Extension of the Milan criteria in the setting of living related liver transplantation may offer more patients a potentially curative treatment, without reducing the donor pool of organs for other patients on the waiting list with nonmalignant liver disease.