Surgical treatment of hepatocellular carcinoma beyond milan criteria. Results of liver resection, salvage transplantation, and primary liver transplantation
Surgical treatment of hepatocellular carcinoma beyond milan criteria. Results of liver resection, salvage transplantation, and primary liver transplantation
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DOI：
10.1245/s10434-008-9851-z
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发表时间：
2008-05-01
影响因子：
3.7
通讯作者：
Sheiner, Patricia A.
中科院分区：
文献类型：
--
作者：
Facciuto, Marcelo E.;Koneru, Baburao;Sheiner, Patricia A.
背景：对于晚期肝细胞癌患者的最佳治疗策略尚无明确的共识。方法：本研究纳入1995年11月至2005年12月间接受肝切除(LR)或直接原位肝移植(OLT)的米兰以外地区的肝硬变和肝癌患者。肿瘤病理分期采用美国肝肿瘤研究组改良的肿瘤-结节-转移分类。结果：23例肝细胞癌患者均接受了肝切除术，其中5例最终接受了保存性原位肝移植。另有32例患者接受了首次原位肝移植。移植后3年和5年的总体精算存活率分别为35%和69%和60%。肝移植术后5年无复发生存率(65%)显著高于肝移植后(26%)。在接受肝移植的患者中，11例(48%)仅在肝脏复发；这11例中有6例表现为晚期肝细胞癌复发、医疗状况差或无病间隔短，不考虑进行移植。早期复发的5例患者接受了挽救原位肝移植(45%的肝移植术后复发，22%的肝移植患者接受肝移植)。术后平均18个月，5名患者全部存活，4名患者无病，1名患者术后16个月出现肝癌复发。结论：对于超过米兰标准的肝癌患者，综合治疗--包括肝移植、原位肝移植和原发原位肝移植--可使半数患者获得长期生存。当有适应症时，通过保留原位肝移植作为早期肝细胞癌复发的备用选择，肝移植可以优化稀缺供体器官的使用。
Background: There is no clear consensus regarding the best treatment strategy for patients with advanced hepatocellular carcinoma (HCC).Methods: Patients with cirrhosis and HCC beyond Milan who had undergone liver resection (LR) or primary orthotopic liver transplantation (OLT) between November 1995 and December 2005 were included in this study. Pathological tumor staging was based on the American Liver Tumor Study Group modified Tumor-Node-Metastasis classification.Results: A total of 23 HCC patients were primarily treated by means of LR, 5 of whom eventually underwent salvage OLT. An additional 32 patients underwent primary OLT. The overall actuarial survival rates at 3 and 5 years were 35% after LR, and 69% and 60%, respectively, after primary OLT. Recurrence-free survival at 5 years was significantly higher after OLT (65%) than after LR (26%). Of the patients who underwent LR, 11 (48%) experienced HCC recurrence only in the liver; 6 of these 11 presented with advanced HCC recurrence, poor medical status, or short disease-free intervals and were not considered for transplantation. Salvage OLT was performed in 5 patients with early stage recurrence (45% of patients with hepatic recurrence after LR and 22% of all patients who underwent LR). At a median of 18 months after salvage OLT, all 5 patients are alive, 4 are free of disease, and 1 developed HCC recurrence 16 months after salvage OLT.Conclusion: For patients with HCC beyond Milan criteria, multimodality treatment-including LR, salvage OLT, and primary OLT-results in long-term survival in half of the patients. When indicated, LR can optimize the use of scarce donor organs by leaving OLT as a reserve option for early stage HCC recurrence.