Impact of pretreatments on outcomes after living donor liver transplantation for hepatocellular carcinoma
Impact of pretreatments on outcomes after living donor liver transplantation for hepatocellular carcinoma
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预处理对肝细胞癌活体肝移植术后结局的影响
DOI：
10.1002/jhbp.602
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发表时间：
2019
影响因子：
3
通讯作者：
Uemoto Shinji
中科院分区：
文献类型：
--
作者：
Ogawa Kohei;Kaido Toshimi;Okajima Hideaki;Fujimoto Yasuhiro;Yoshizawa Atsushi;Yagi Shintaro;Hori Tomohide;Iida Taku;Takada Yasutsugu;Uemoto Shinji
背景本研究的目的是探讨预处理对肝细胞癌（HCC）活体肝移植（LDLT）后结局的影响。方法1999年2月至2015年3月，223例HCC患者接受了活体肝移植（LDLT）。直到2006年12月，关于肿瘤数量和大小的患者选择标准没有限制，自2007年1月起我们执行京都标准（肿瘤数量≤10，最大直径≤5cm，脱γ-羧基凝血酶原≤400mAU/ml）。结果在223名患者中，156名有预处理史。在 101 名初次诊断时符合米兰标准的患者中，有 38 名患者在肝移植 (LT) 时进展到超出标准。 38 例中有 22 例符合京都标准，其生存率和复发率显着优于超过京都标准的患者（P 分别为 0.004 和 0.035）。关于预处理次数（0次 vs. 1-4次 vs. ≥5次），≥5次预处理组的复发率显着高于0次组。然而，对于符合京都标准的患者，这三组之间的复发率没有显着差异。结论对于符合京都标准的HCC，即使经过重复的预处理，进行LT也会取得更好的结果。
BackgroundThe purpose of this study was to examine the impact of pretreatments on outcomes after living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC).MethodsFrom February 1999 to March 2015, 223 patients underwent LDLT for HCC. Until December 2006, there was no restriction in patient selection criteria regarding the number and size of tumors, following which we implemented the Kyoto criteria (tumor number ≤10, maximal diameter ≤5 cm, and des‐gamma‐carboxy prothrombin ≤400 mAU/ml) since January 2007.ResultsOf 223 patients, 156 had a history of pretreatments. Among 101 patients meeting the Milan criteria at the initial diagnosis, 38 progressed to beyond the criteria at liver transplantation (LT). Twenty‐two out of 38 met the Kyoto criteria, and their survival and recurrence rates were significantly better than those of patients exceeding the Kyoto criteria (P= 0.004 and 0.035, respectively). Regarding the number of pretreatments (0 vs. 1–4 vs. ≥5), recurrence rate was significantly higher in the ≥5 pretreatments group than the 0 group. However, for patients meeting the Kyoto criteria, there were no significant differences in recurrence rates between these three groups.ConclusionBetter outcomes will be achieved by performing LT for HCCs meeting the Kyoto criteria even after repeated pretreatments.