SECTION 5. FURTHER EXPANDING THE CRITERIA FOR HCC IN LIVING DONOR LIVER TRANSPLANTATION: WHEN NOT TO TRANSPLANT: SNUH EXPERIENCE
SECTION 5. FURTHER EXPANDING THE CRITERIA FOR HCC IN LIVING DONOR LIVER TRANSPLANTATION: WHEN NOT TO TRANSPLANT: SNUH EXPERIENCE
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DOI：
10.1097/01.tp.0000446269.20934.d3
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发表时间：
2014-04-27
期刊：
影响因子：
6.2
通讯作者：
Suh, Kyung-Suk
中科院分区：
文献类型：
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作者：
Lee, Kwang-Woong;Yi, Nam-Joon;Suh, Kyung-Suk
活体肝移植（LDLT）是亚洲国家治疗肝细胞癌（HCC）的重要方式之一。肝细胞癌的LDLT治疗占首尔国立大学医院（SNUH）总LDLT的50%。米兰或加州大学旧金山分校（UCSF）的标准不被认为是SNUH LDLT的绝对选择标准。我们经历了一些超过米兰标准的患者在LDLT后的长期生存。相反，在我们的研究中，在符合UCSF标准的患者中，LDLT的预后比已故供体LT （DDLT）差。LDLT复发率高的原因有以下几个方面，如快速通道选择和快速再生。因此，基于肿瘤大小和数量的传统标准预测LDLT术后HCC复发的可行性似乎与DDLT有所不同。我们确定了重要的术前生物学因素，如AFP、PIVKAII和PET阳性。结合这些生物学因素预测HCC复发比基于大小和数量的传统标准更好。三种危险因素均为100%复发率。无论米兰的标准如何，这一组都应该被排除在外。关于扩大LDLT的标准一直存在争议。一些中心仍然坚持扩大的标准，估计5年生存率约为50%。然而，目前还没有完全量身定制的标准来准确预测HCC复发。复发后的生存率也因病例而异。此外，m-TOR抑制剂和靶向药物的引入提高了复发后的生存率。基于这些想法，我们通过实验将适应症扩展到远晚期HCC （HCC大于10 cm或大于10个细胞或术前有大血管侵犯）。远晚期HCC患者通常预后较差。然而，所选的AFP (
Living donor liver transplant (LDLT) is one of the important modalities to treat hepatocellular carcinoma (HCC) in Asian countries. LDLT for HCC consists of >50% of the total LDLT at Seoul National University Hospital (SNUH). Milan or University of California San Francisco (UCSF) criteria were not considered as absolute selection criteria for LDLT at SNUH. We experienced that some patients with beyond Milan criteria have long-term survival after LDLT. On the contrary, LDLT showed poorer outcome than deceased donor LT (DDLT) in patients with within UCSF criteria in our series. There are several reasons for higher recurrence rate in LDLT such as fast-track selection and rapid regeneration in LDLT. Therefore, the feasibility of conventional criteria based on tumor size and number to predict HCC recurrence after LDLT seemed somewhat different from that of DDLT. We identified significant pre-operative biological factors such as AFP, PIVKAII, and PET positivity. Combination of those biological factors predicted HCC recurrence better than conventional criteria based on size and number. All patients with three risk factors showed 100% recurrence. This group should be excluded regardless of Milan criteria.There have been debates in expanding the criteria in LDLT. Some centers still stick on the expanded criteria that are estimated to yield a 5-year survival of approximately 50%. However, there was no completely tailored criterion to predict HCC recurrence exactly. The survival after recurrence was also different from case by case. Furthermore, the introduction of m-TOR inhibitor and targeted agent improved survival after recurrence. Based on these ideas, we experimentally expanded our indication to the far advanced HCC (HCC larger than 10 cm or more than 10 numbers or with macrovascular invasion preoperatively). The patients with far advanced HCC have usually poor prognosis. However, the selected patients with low AFP (