Resection for hepatocellular carcinoma is a good option in Child-Turcotte-Pugh class A patients with cirrhosis who are eligible for liver transplantation
Resection for hepatocellular carcinoma is a good option in Child-Turcotte-Pugh class A patients with cirrhosis who are eligible for liver transplantation
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DOI：
10.1002/lt.20398
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发表时间：
2005-10-01
影响因子：
4.6
通讯作者：
Bilbao, I
中科院分区：
文献类型：
--
作者：
Margarit, C;Escartín, A;Bilbao, I
对于单发、早期肝细胞癌(HCC)和肝硬变、肝功能良好、无门脉高压的患者，最佳治疗方案仍有待确定。本研究的目的是比较肝切除(LR)和肝移植(LT)对年龄在70岁以下的肝硬变Child-Turcotte-Pugh A级早期肝癌患者的疗效。在我科接受肝移植治疗的134名患者中有37名符合纳入标准，125名接受肝移植治疗的患者中有36名符合纳入标准。平均肿瘤大小(3厘米)无差异；肝移植组以丙型肝炎肝硬变为主，而肝移植组以高龄为主。LT组术后死亡率较高，住院时间较长。两组患者的存活率相似。肝移植组肿瘤复发率较高(59%比11%)，肝移植后以肝外复发为主，肝移植后以肝复发为主。肝移植后的无瘤存活率显著提高。肝移植术后复发18例，晚期5例，早期13例。17名患者-13名早期肝细胞癌复发和4名肝功能衰竭-是挽救肝移植的潜在候选者。然而，在这个时候，17名患者中有10名年龄超过70岁。挽救肝移植仅6例，5例为肝细胞癌复发，1例为肝功能衰竭。补救性肝移植的结果与原始性肝移植相似。总而言之，只有27.6%的切除患者有资格接受肝移植。LR是一个很好的选择，因为它提供了与LT相似的存活率。16.2%的患者施行了保留性肝移植，高龄是主要禁忌症。补救性肝移植的结果与初次肝移植相似。
The best treatment option for patients with single, early hepatocellular carcinoma (HCC) and cirrhosis, good liver function, and absence of portal hypertension remains to be established. The aim of this work was to compare the outcome of liver resection (LR) with that of liver transplantation (LT) for single, early HCC in Child-Turcotte-Pugh class A patients with cirrhosis younger than 70 years of age. Thirty-seven of 134 patients who underwent LR and 36 of 125 who underwent LT for HCC in our unit fulfilled the inclusion criteria. No differences were observed in mean tumor size (3 cm); HCV cirrhosis predominated in the LT group and older age in the LR group. Postoperative mortality was higher and hospital stay longer in the LT group. Patient survival was similar in both groups. Tumor recurrence was higher in the LR group (59% vs. 11%), extrahepatic recurrences predominated after LT and hepatic recurrences after LR. Disease-free survival was significantly better after LT. Eighteen patients presented hepatic recurrence after LR: 5 advanced and 13 early. Seventeen patients-13 with early HCC recurrence and 4 with liver failure-were potential candidates for salvage LT. However, 10 of 17 patients were older than 70 years at this time. Salvage LT could only be performed in 6 patients: 5 for HCC recurrence and 1 for liver failure. Results of salvage LT were similar to those of primary LT. In conclusion, only 27.6% of resected patients were eligible for LT. LR is a good option since it offers similar survival to LT. Salvage liver transplantation was performed in 16.2% of resected patients, with older age being the main contraindication. Outcome for salvage LT was similar to that of primary LT.