Difference in tumor invasiveness in cirrhotic patients with hepatocellular carcinoma fulfilling the Milan criteria treated by resection and transplantation - Impact on long-term survival
Difference in tumor invasiveness in cirrhotic patients with hepatocellular carcinoma fulfilling the Milan criteria treated by resection and transplantation - Impact on long-term survival
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DOI：
10.1097/01.sla.0000225255.01668.65
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发表时间：
2007-01-01
影响因子：
9
通讯作者：
Wong, John
中科院分区：
文献类型：
--
作者：
Poon, Ronnie T. P.;Fan, Sheung Tat;Wong, John
背景资料：先前的一些研究表明，小肝细胞癌（HCC）移植后比切除后生存率更高，但尚未研究移植和切除患者肿瘤侵袭性差异的影响。本研究比较了符合米兰标准的HCC患者通过切除或移植治疗的肿瘤特征，并阐明了它们对长期生存的影响。患者和方法：比较了符合米兰标准的204例肝硬化肝癌切除术患者和43例肝硬化肝癌移植患者的肿瘤特征和长期生存。通过多变量分析确定所有切除或移植患者的预后因素。结果：移植组肿瘤的高级别肿瘤、显微静脉侵犯和微卫星结节的发生率较低。移植组总体5年生存率优于切除组（81% vs. 68%， P=0.017）。然而，根据有无静脉侵入进行分层时，两组患者的生存率无显著差异。多因素分析显示，丙型肝炎病毒血清学、肿瘤大小、肿瘤数量和显微静脉侵入，但不包括切除或移植，对预后有重要意义。结论：由于选择偏倚，即使在肿瘤符合米兰标准的患者中，移植和切除治疗HCC的肿瘤侵袭性也存在显著差异。当考虑不同肿瘤侵袭性时，切除或移植后的长期生存无显著差异。
Background Data: Some previous studies demonstrated better survival after transplantation for small hepatocellular carcinoma (HCC) compared with resection, but the influence of differences in tumor invasiveness between transplanted and resected patients has not been studied. This study compared the tumor characteristics of patients with HCC within the Milan criteria treated by resection or transplantation, and elucidated their impact on long-term survival.Patients and Methods: Tumor characteristics and long-term survival of 204 cirrhotic patients with resection and 43 cirrhotic patients with transplantation for HCC within the Milan criteria were compared. A multivariate analysis was performed to determine the prognostic factors of survival in all patients with resection or transplantation.Results: Tumors in the transplanted group were associated with lower incidence of high-grade tumors, microscopic venous invasion, and microsatellite nodules. The overall 5-year survival was better in the transplantation group than the resection group (81% vs. 68%, P=0.017). However, there were no significant differences in survival between the two groups when stratified according to presence or absence of venous invasion. Multivariate analysis showed that hepatitis C virus serology, tumor size, tumor number, and microscopic venous invasion, but not resection or transplantation, were of prognostic significance.Conclusions: There were significant differences in tumor invasiveness in HCC treated by transplantation and resection as a result Of selection bias, even in patients with the tumors fulfilling the Milan criteria. When the different tumor invasiveness was taken into account, there was no significant difference in the long-term survival after resection or transplantation.