Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria.
Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria.
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DOI：
10.1002/hep.27752
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发表时间：
2015-06
期刊：
影响因子：
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通讯作者：
Roberts JP
中科院分区：
文献类型：
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作者：
Yao FY;Mehta N;Flemming J;Dodge J;Hameed B;Fix O;Hirose R;Fidelman N;Kerlan RK Jr;Roberts JP
我们报告了自2002年以来118例肝细胞癌（HCC）在肝移植（LT）前降期至米兰/UNOS T2标准的长期意向治疗结果，并将其与同期488例肝移植（LT）患者的结果进行了比较。低分期亚组包括1个> ~ 5cm≤8cm病变（n=43）， 2 ~ 3个至少1个> ~ 3cm≤5cm病变，肿瘤总直径≤8cm (n=61)，或4 ~ 5个各≤3cm病变，肿瘤总直径≤8cm （n=14）。在低分期组中，64例（54.2%）患者接受了肝移植，5例（7.5%）HCC复发。5例HCC复发患者中2例就诊时肿瘤有4-5个。低分期组1年和2年的累计退出概率（竞争风险）分别为24.1%和34.2%，而T2组为20.3%和25.6% （p=0.04）。Kaplan-Meier移植后5年生存率和无复发概率在低分期组分别为77.8%和90.8%，而T2组分别为81%和88% （p=0.69和p=0.66）。低分期组的5年意向治疗生存率为56.1%，而T2组为63.3% （p=0.29）。预测低分期组患者退出的因素包括治疗前甲胎蛋白≥1000 ng/mL（多变量HR 2.42, p=0.02）和Child 's B与Child 's A肝硬化（多变量HR 2.19, p=0.04）。结论：HCC成功降期至T2标准内，与满足T2标准而未降期的患者相比，HCC复发率低，移植后生存率高。由于4-5个肿瘤的患者数量较少，需要进一步的研究来证实降分期在该亚组中的疗效。
We report long-term intention-to-treat outcome of 118 patients with hepatocellular carcinoma (HCC) undergoing down-staging to within Milan/UNOS T2 criteria before liver transplantation (LT) since 2002, and compare the results with 488 patients listed for LT with HCC meeting T2 criteria at listing in the same period. The down-staging subgroups include 1 lesion >5 cm and ≤8 cm (n=43), 2 or 3 lesions at least one >3 cm and ≤5 cm with total tumor diameter ≤8 cm (n=61), or 4 to 5 lesions each ≤3 cm with total tumor diameter ≤8 cm (n=14). In the down-staging group, 64 patients (54.2%) had received LT, and 5 (7.5%) developed HCC recurrence. Two of the 5 patients with HCC recurrence had 4–5 tumors at presentation. The 1- and 2-year cumulative probabilities for dropout (competing risk) were 24.1% and 34.2% in the down-staging group, versus 20.3% and 25.6% in the T2 group (p=0.04). The Kaplan-Meier 5-year post-transplant survival and recurrence-free probabilities were 77.8% and 90.8%, respectively, in the down-staging group, versus 81% and 88%, respectively, in the T2 group (p=0.69 and p=0.66, respectively). The 5-year intention-to-treat survival was 56.1% in the down-staging group, versus 63.3% in the T2 group (p=0.29). Factors predicting dropout in the down-staging group included pre-treatment alpha-fetoprotein ≥1000 ng/mL (multivariate HR 2.42, p=0.02) and Child’s B versus Child’s A cirrhosis (multivariate HR 2.19, p=0.04). Conclusion: Successful down-staging of HCC to within T2 criteria was associated with a low rate of HCC recurrence and excellent post-transplant survival, comparable to those meeting T2 criteria without down-staging. Due to the small number of patients with 4–5 tumors, further investigations are needed to confirm the efficacy of down-staging in this subgroup.