Liver Transplantation Versus Liver Resection for the Treatment of Hepatocellular Carcinoma
Liver Transplantation Versus Liver Resection for the Treatment of Hepatocellular Carcinoma
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DOI：
10.1002/jso.21415
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发表时间：
2010-01-01
影响因子：
2.5
通讯作者：
Park, Jung Hyun
中科院分区：
文献类型：
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作者：
Lee, Kyung Keun;Kim, Dong Goo;Park, Jung Hyun
目的：肝切除（LR）和肝移植（LT）被认为是仅有的两种可能治愈肝细胞癌（HCC）的治疗方法。最近，对于肝硬化Child A或B级患者的最佳初始治疗是LR还是LT，存在激烈的争论。本研究的目的是比较LR和LT的结果在肝癌患者和儿童A或B肝硬化在一个单一的中心超过10 years period.Method：78例患者进行了治疗LT和130与LR治疗。结果：LT组患者住院时间明显长于LR组（P <0.001），而LR组患者住院时间明显长于LT组（P < 0.001）。两组术后并发症发生率和早期手术死亡率相似。LT后的总生存率高于LR后，但没有达到统计学显著性程度（P = 0.267）。LT后无复发生存率显著高于LR后（P = 0.002）。在米兰标准以内和以外，LT后的总生存率高于LR后，但没有达到统计学显著性程度。符合米兰标准的患者行肝移植术后无复发生存率明显高于肝移植术后（P < 0.001）。肝癌切除术后复发率（51.5%）高于肝移植术后复发率（29.5%）（P < 0.001），肝移植术后肝癌复发率高于肝移植术后（P = 0.002）。但复发后，肝移植术的生存率高于肝移植术，但差异无统计学意义（P = 0.177）。结论：肝移植术应作为符合米兰标准的原发性肝癌的首选治疗方法。对于超出米兰标准的肝癌患者，建议进行LR。LT组的复发率明显低于LR组。然而，在复发的情况下，LT组显示出比LR组更差的长期结局。外科肿瘤学杂志2010;101：47-53. (C)2009威利-利斯公司
Purpose: Liver resection (LR) and liver transplantation (LT) are considered the only two potentially curative treatments for hepatocellular carcinoma (HCC). Recently, there has been an intense debate as to whether LR or LT is the optimal initial treatment for patients with Child A or B cirrhosis. The aim of this study was to compare the results of LR and LT in patients with HCC and with Child A or B cirrhosis in a single center over a 10-year period.Method: Seventy-eight patients were treated with LT and 130 were treated with LR. We evaluated patient characteristics, short-term results such as hospital stay, postoperative complication, mortality, and long-term results such as overall and recurrence-free survival and recurrence.Results: The hospital stay of the LT group was significantly longer than that of the LR group (P < 0.001). The postoperative complication rate and the early operative mortality rate were similar between the two groups. The overall survival rate was higher after LT than it was after LR, but not to a statistically significant degree (P = 0.267). The recurrence-free survival rate was significantly higher after LT than it was after LR (P = 0.002). Within and beyond the Milan criteria, the overall survival rate was higher after LT than it was after LR, but not to a statistically significant degree. The recurrence-free survival rate was significantly higher after LT than it was after LR in the patients within Milan criteria (P < 0.001). HCC recurred more frequently after resection (51.5%) than it did after transplantation (29.5%) (P < 0.001), and HCC recurrence developed in the liver more frequently after LR than it did after LT (P = 0.002). However, after recurrence, LR had better survival than LT did, but not to a statistically significant degree (P = 0.177).Conclusion: LT should be considered as the primary treatment in patients with HCC within the Milan criteria. LR is recommended for patients with HCC beyond the Milan criteria. The LT group showed a significantly lower recurrence rate than the LR group. However, in the case of recurrence, the LT group showed a poorer long-term outcome than the LR group. J. Surg. Oncol. 2010;101:47-53. (C) 2009 Wiley-Liss, Inc.