Predictor of outcome after living donor liver transplantation for patients with hepatocellular carcinoma beyond the Japan criteria
Predictor of outcome after living donor liver transplantation for patients with hepatocellular carcinoma beyond the Japan criteria
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DOI：
10.1002/ags3.12335
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发表时间：
2020-04-24
影响因子：
2.7
通讯作者：
Mori, Masaki
中科院分区：
文献类型：
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作者：
Yonemura, Yusuke;Yoshizumi, Tomoharu;Mori, Masaki
背景日本标准(JC，肿瘤最大直径在5 cm以内，5个肿瘤结节内，AFP在500 ng/m L或米兰标准内)已被应用于肝细胞癌的身体肝移植(LT)，并将用于日本的活体供肝移植(LDLT)。这项研究的目的是验证LDLT中的JC，并阐明除JC外，LDLT术后肝癌复发和死亡的危险因素。患者和方法回顾2019年10月至2019年10月接受LDLT治疗的终末期肝癌患者(n=246)。根据患者是否在JC内(n=203)和JC外(n=43)，将患者分为两组。比较LDLT术后无复发存活率或总存活率。采用单因素和多因素分析，分析JC外患者LDLT后肝癌复发和相关死亡率的危险因素。结果JC外患者的5年无复发生存率(50.3%vs95.9%，P<；.001)或总体生存率(61.7%vs98.1%，P<；.001)显著低于JC内患者。多因素分析显示，DES-γ-羧基凝血酶原(Dcp)和Gt；=300MAU/m L(风险比9.36，95%CI；2.41~36.4，P=.001)是影响JC以外患者LDLT术后肝细胞癌复发和相关死亡率的独立危险因素(风险比13.8，95%CI；1.92~98.6，P=0.01)。超过JC且DCP>；=300MAU/mL的患者可能禁忌行LDLT。
Background The Japan criteria (JC, maximum tumor size within 5 cm, within five tumor nodules, AFP within 500 ng/mL or within Milan criteria) have been applied to cadaveric liver transplantation (LT) for hepatocellular carcinoma (HCC) and will be used for living donor LT (LDLT) in Japan. The aim of this study was to verify the JC in LDLT and to clarify the risk factor of HCC recurrence and mortality after LDLT beyond the JC.Patients and methods Adult patients who underwent LDLT for end-stage liver disease with HCC until October 2019 were reviewed retrospectively (n = 246). Patients were divided into two groups according to whether they were within JC (n = 203) or beyond JC (n = 43). Recurrence-free or overall survival rates after LDLT were compared. Univariate and multivariate analyses were performed to identify risk factors of HCC recurrence and HCC-related mortality after LDLT for patients beyond the JC.Results Patients beyond the JC had significantly poorer 5-year recurrence-free (50.3% vs 95.9%, P < .001) or overall (61.7% vs 98.1%, P < .001) survival rates compared with patients within the JC. A multivariate analysis revealed that des-gamma-carboxy prothrombin (DCP) >= 300 mAU/mL (hazard ratio 9.36, 95% CI; 2.41-36.4, P = .001) was an independent risk factor for HCC recurrence and HCC-related mortality (hazard ratio 13.8, 95% CI; 1.92-98.6, P = .01) after LDLT in patients beyond the JC.Conclusion The outcome of LDLT for patients within the JC was favorable. Patients beyond the JC with DCP >= 300 mAU/mL might be contraindicated for LDLT.