Transplantation for Hepatocellular Carcinoma: Is There a Tumor Size Limit?
Transplantation for Hepatocellular Carcinoma: Is There a Tumor Size Limit?
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DOI：
10.1016/j.transproceed.2018.04.038
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发表时间：
2018-12-01
影响因子：
0.9
通讯作者：
Gaber, A. O.
中科院分区：
文献类型：
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作者：
Daoud, A.;Teeter, L.;Gaber, A. O.
背景基于肿瘤大小的肝细胞癌（HCC）移植标准（米兰和加州大学旧金山弗朗西斯科[UCSF]）的出现促进了肿瘤患者接受移植。最近在移植较大肿瘤患者（超出UCSF）的成功需要了解患者，肿瘤和生物学标准，这些标准决定了所有大小标准的HCC移植的成功结局。我们分析了2002年至2013年期间接受奥尔特的11，928例患者，这些患者来自器官共享标准移植分析和研究联合网络文件。根据移植时的肿瘤大小比较临床结局;米兰（n = 11，555），UCSF内的米兰以外（n = 291），以及米兰和UCSF以外（n = 82）。进行统计学分析，以确定影响生存的因素。3个患者组之间的1年、3年和5年生存率无统计学显著差异（米兰内91.1%、74.8%和60.3%;米兰以外UCSF内92.7%、71.1%和51.6%;米兰和UCSF以外95.8%、75.9%和58.1%）。在多变量分析中，显著影响生存的因素包括AA种族、AFP >3000和丙型肝炎感染，而年龄、糖尿病和最大肿瘤直径的影响较小。总肿瘤负荷和移植时间不是生存率的显著预测因素。这些数据表明，根据目前的临床选择标准，少数大肿瘤可以通过移植成功治疗，并指出需要将HCC生物学行为的标志物纳入移植标准的大小和肿瘤负荷之外。
Background. The advent of tumor-size based criteria (Milan and University of California, San Francisco [UCSF]) for the transplantation of hepatocellular carcinomas (HCC) has facilitated tumor patients' access to transplantation. Recent success in transplanting patients with larger tumors (beyond UCSF) necessitates an understanding of the patient, the tumor, and biological criteria that determine successful outcomes for HCC transplantation across all size criteria.Methods. We analyzed 11,928 patients who received OLT between 2002 and 2013 from the United Network for Organ Sharing Standard Transplant Analysis and Research file. Clinical outcomes were compared by tumor size at transplant; Milan (n = 11,555), beyond Milan within UCSF (n = 291), and beyond both Milan and UCSF (n = 82). A statistical analysis was conducted to determine the factors impacting survival.Results. There were no statistically significant differences in the 1-, 3-, and 5-year survival rates between the 3 patient groups (within Milan 91.1%, 74.8%, and 60.3%; beyond Milan within UCSF, 92.7%, 71.1%, and 51.6%; and beyond Milan and UCSF 95.8%, 75.9%, and 58.1%). In a multivariate analysis, factors significantly affecting survival included, AA race, AFP >3000, and hepatitis C infection, while age, diabetes and largest tumor diameter had a more modest impact. Total tumor burden and time to transplantation were not significant predictors of survival.Conclusions. These data indicate that, based on current clinical selection criteria, a small number of large tumors can be successfully treated by transplantation and points to the need to include markers of HCC biologic behavior beyond size and tumor burden to transplant criteria.