Liver Transplantation for Nonresectable Liver Metastases From Colorectal Cancer
Liver Transplantation for Nonresectable Liver Metastases From Colorectal Cancer
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DOI：
10.1097/sla.0b013e3182823957
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发表时间：
2013-05-01
影响因子：
9
通讯作者：
Dueland, Svein
中科院分区：
文献类型：
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作者：
Hagness, Morten;Foss, Aksel;Dueland, Svein
目的：本研究的目的是探讨结直肠癌肝转移（CLMs）肝移植后长期总生存率（OS）的可能性。背景：不可切除的CLMs患者预后不良，很少有生存超过5年的。CLM目前被认为是肝移植的绝对禁忌症，尽管原发性和一些继发性肝脏恶性肿瘤的肝移植在选定的患者中显示出良好的结果。在1995年之前，进行了几次肝移植治疗CLMs，但结果很差（5年生存率：18%），肝移植治疗CLMs被放弃。从那时起，肝移植后的存活率总体上提高了近30%。在此基础上，肝移植后CLMs的5年生存率约为50%.Methods：在一项前瞻性的试点研究，肝移植不可切除CLMs进行（n=21）。主要入选标准为肝脏CLMs，切除原发性肿瘤，至少6周的chemotherapy.Results：Kaplan-Meier估计的OS率在1，3和5年分别为95%，68%和60%。疾病的转移复发是常见的（主要是肺）。然而，很大一部分复发的患者可以手术治疗，在随访时（中位数为27个月;范围为8-60个月），33%的患者没有疾病的证据。肝移植前的肝肿瘤负荷，从原发性手术到肝移植的时间，化疗和疾病进展被确定为显着的预后factors.Conclusions：OS超过迄今为止报道的结果化疗，这是唯一的治疗选择可用于此患者组。此外，对于可切除的CLM，OS与肝切除相当，对于非恶性疾病，再次肝移植后的生存率也相当。基于预后因素的选择策略可能会进一步改善结局（ClinicalTrials.gov：NCT 01311453）。
Objective: The objective of this pilot study was to investigate the potential for long-term overall survival (OS) after liver transplantation for colorectal liver metastases (CLMs).Background: Patients with nonresectable CLMs have poor prognosis, and few survive beyond 5 years. CLMs are currently considered an absolute contraindication for liver transplantation, although liver transplantation for primary and some secondary liver malignancies shows excellent outcome in selected patients. Before 1995, several liver transplantations for CLMs were performed, but outcome was poor (5-year survival rate: 18%) and liver transplantation for CLMs was abandoned. Since then, the survival rate after liver transplantation in general has improved by almost 30%. On the basis of this, a 5-year survival rate of about 50% after liver transplantation for CLMs could be anticipated.Methods: In a prospective pilot study, liver transplantation for nonresectable CLMs was performed (n=21). Main inclusion criteria were liver-only CLMs, excised primary tumors, and at least 6 weeks of chemotherapy.Results: Kaplan-Meier estimates of the OS rate at 1, 3, and 5 years were 95%, 68%, and 60%, respectively. Metastatic recurrence of disease was common (mainly pulmonary). However, a significant proportion of the recurrences were accessible for surgery, and at follow-up (after median of 27 months; range, 8-60), 33% had no evidence of disease. Hepatic tumor load before liver transplantation, time from primary surgery to liver transplantation, and progressive disease on chemotherapy were identified as significant prognostic factors.Conclusions: OS exceeds by far reported outcome for chemotherapy, which is the only treatment option available for this patient group. Furthermore, OS is comparable with liver resection for resectable CLMs and survival after repeat liver transplantation for nonmalignant diseases. Selection strategies based on prognostic factors may further improve the outcome (ClinicalTrials.gov: NCT01311453).