Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis
Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis
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DOI：
10.1056/nejm199603143341104
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发表时间：
1996-03-14
影响因子：
158.5
通讯作者：
Gennari, L
中科院分区：
文献类型：
--
作者：
Mazzaferro, V;Regalia, E;Gennari, L
背景原位肝移植在治疗肝硬化和肝细胞癌患者中的作用存在争议，并且很难确定哪些患者在肝移植后可能获得良好的结果。方法。我们研究了48例肝硬化患者，这些患者患有小的不可切除的肝细胞癌，并接受了肝移植。在94%的患者中，肝硬化与B型肝炎病毒、丙型肝炎病毒或两者的感染有关。肿瘤的存在通过活检或血清甲胎蛋白测定来证实。移植资格的标准是在患有单个肝细胞癌的患者中存在直径为5 cm或更小的肿瘤，并且在患有多个肿瘤的患者中不超过3个肿瘤结节，每个肿瘤结节的直径为3 cm或更小。28例肝功能良好的患者在移植前接受了肿瘤治疗，主要是化疗栓塞。肝移植术后随访9 ~ 54个月（中位时间26个月），术后未给予任何抗癌治疗。总死亡率为17%。四年后，精算生存率为75%，无复发生存率为83%。肝细胞癌复发4例（8%）。35例患者的4年总生存率和无复发生存率73%的患者在切除的肝脏病理检查中符合预定的小肝癌选择标准，分别为85%和92%，而13例患者的比率为85%和92%。（27%），其肿瘤超过这些限制分别为50%和59%（总生存率P=0.01;无复发生存率P=0.002）。在本组48例早期肿瘤患者中，肿瘤淋巴结转移状态、肿瘤数量、血清甲胎蛋白浓度、移植前接受的治疗等10个变量与生存率无显著相关性。肝移植是治疗肝硬化合并不能切除的小肝癌的有效方法。
Background. The role of orthotopic liver transplantation in the treatment of patients with cirrhosis and hepatocellular carcinoma is controversial, and determining which patients are likely to have a good outcome after liver transplantation is difficult.Methods. We studied 48 patients with cirrhosis who had small, unresectable hepatocellular carcinomas and who underwent liver transplantation. In 94 percent of the patients, the cirrhosis was related to infection with hepatitis B virus, hepatitis C virus, or both. The presence of tumor was confirmed by biopsy or serum alpha-fetoprotein assay. The criteria for eligibility for transplantation were the presence of a tumor 5 cm or less in diameter in patients with single hepatocellular carcinomas and no more than three tumor nodules, each 3 cm or less in diameter, in patients with multiple tumors. Twenty-eight patients with sufficient hepatic function underwent treatment for the tumor, mainly chemoembolization, before transplantation. After liver transplantation, the patients were followed prospectively for a median of 26 months (range, 9 to 54), No anticancer treatment was given after transplantation.Results. The overall mortality rate was 17 percent. After four years, the actuarial survival rate was 75 percent and the rate of recurrence-free survival was 83 percent. Hepatocellular carcinoma recurred in four patients (8 percent). The overall and recurrence-free survival rates at four years among the 35 patients (73 percent of the total) who met the predetermined criteria for the selection of small hepatocellular carcinomas at pathological review of the explanted liver were 85 percent and 92 percent, respectively, whereas the rates in the 13 patients (27 percent) whose tumors exceeded these limits were 50 percent and 59 percent, respectively (P=0.01 for overall survival; P=0.002 for recurrence-free survival). In this group of 48 patients with early-stage tumors, tumor-node-metastasis status, the number of tumors, the serum alphafetoprotein concentration, treatment received before transplantation, and 10 other variables were not significantly correlated with survival.Conclusions. Liver transplantation is an effective treatment for small, unresectable hepatocellular carcinomas in patients with cirrhosis.