Incidence of Occult Intrahepatic Metastasis in Hepatocellular Carcinoma Treated With Transplantation Corresponds to Early Recurrence Rates After Partial Hepatectomy.
Incidence of Occult Intrahepatic Metastasis in Hepatocellular Carcinoma Treated With Transplantation Corresponds to Early Recurrence Rates After Partial Hepatectomy.
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DOI：
10.1097/sla.0000000000002135
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发表时间：
2018-05
影响因子：
9
通讯作者：
Levine MH
中科院分区：
文献类型：
--
作者：
Aufhauser DD Jr;Sadot E;Murken DR;Eddinger K;Hoteit M;Abt PL;Goldberg DS;DeMatteo RP;Levine MH
本研究旨在比较原位肝移植（OLTs）移植肝标本中放射学上无法识别的（隐匿的）肝细胞癌（HCC）病变的发生率与肝癌切除术后肝内复发率。肝细胞癌切除术与肝内肝细胞癌复发率高相关。然而，尚不清楚这些复发是否代表原发肿瘤未被识别的转移灶未完全切除，或由于HCC形成的固有生物学倾向而导致肿瘤重新形成。我们收集了来自器官获取和移植（OPTN）国家数据库中的3696例肝移植手术患者、299例单个移植中心的肝移植手术患者和232例肝胆癌中心的部分肝切除术患者、肿瘤和病理数据。在OPTN和大容量移植中心队列中，分别有37%和42%的患者在外植体病理上有隐匿性HCC病变。在癌症中心的患者中，2年复发率为46%，74%的复发患者仅表现为肝脏复发。尽管移植和切除人群不同，但隐匿性多灶性在移植外植体中很常见，与部分肝切除术后46%的早期复发率相似。这些数据表明，非治愈性切除通常是由于切除时存在的肝内隐匿性多灶性，而不是由于残肝伴新发肿瘤的恶性易感。
This study aimed to compare the incidence of radiologically unrecognized (occult) hepatocellular carcinoma (HCC) lesions in explant hepatectomy specimens from orthotopic liver transplants (OLTs) performed for HCC with rates of HCC intrahepatic recurrence after resection. Resection of HCC is associated with high rates of intrahepatic HCC recurrence. However, it is unclear whether these recurrences represent incomplete resection of unrecognized metastatic lesions from the primary tumor or subsequent de novo tumor formation due to inherent biological proclivity for HCC formation. We collected patient, tumor, and pathology data on HCC patients treated surgically from 3696 OLTs in the Organ Procurement and Transplantation (OPTN) national database, 299 OLTs at a single transplant center, and 232 partial hepatectomies from a hepatobiliary cancer center. In the OPTN and high-volume transplant center cohorts, 37% and 42% of patients had occult HCC lesions on explant pathology, respectively. Among cancer center patients, the 2-year recurrence rate was 46%, and 74% of patients who recurred presented with liver only recurrence. Although the transplant and resection populations differ, occult multifocality is common in transplant explants and similar to the 46% early recurrence rate following partial hepatectomy. These data suggest that non-curative resection often results from occult intrahepatic multifocality present at the time of resection rather than a malignant predisposition of the remnant liver with de novo tumorigenesis.