Should hepatomas be treated with hepatic resection or transplantation?
Should hepatomas be treated with hepatic resection or transplantation?
复制标题
肝癌应该进行肝切除还是肝移植治疗？
DOI：
10.1002/(sici)1097-0142(19991001)86:7
复制
发表时间：
1999
期刊：
影响因子：
6.2
通讯作者：
Starzl,TE
中科院分区：
文献类型：
--
作者：
Yamamoto,J;Iwatsuki,S;Kosuge,T;Dvorchik,I;Shimada,K;Marsh,JW;Yamasaki,S;Starzl,TE
背景：这项合作研究的目的是比较肝切除术（Hx）和原位肝移植（OLTx）对大量肝硬化肝细胞癌（HCC）患者的长期疗效，并描述这两种手术治疗的作用。方法交换日本国立癌症中心医院和美国匹兹堡大学医学中心的数据库，选择294例接受根治性Hx治疗的肝硬化患者和270例接受根治性OLTx治疗的肝硬化患者进行比较。结果Hx治疗后30 d内死亡率和150 d内死亡率均显著低于OLTx治疗后（P= 0.001和P= 0.00007）。Hx组和OLTx组的总生存率相似（P= 0.40）。与无宏观血管侵犯及淋巴结转移的HCC患者相比，OLTx术后的总生存率显著高于Hx术后（P= 0.006）。然而，Hx组中Child - Pugh A级肿瘤患者与OLTx组中所有患者（大多数为Child - Pugh C级肿瘤）之间的差异不显著（P= 0.25）。OLTx后的无瘤生存率显著高于Hx后的无瘤生存率（P< 0.0001），尤其是尺寸≤5 cm的hcc、单侧分布的肿瘤以及没有或只有显微血管浸润的hcc。Hx组和OLTx组的无瘤生存率无统计学差异。结论在器官短缺的情况下，在代偿良好的肝硬化中发生的HCC可采用Hx治疗。然而，作者认为OLTx应该选择性地应用于那些肿瘤复发和/或进行性肝功能衰竭的患者。癌症1999;86:1151-8。©1999美国癌症协会。
BACKGROUNDThe aim of this collaborative study was to compare the long term results of hepatic resection (Hx) with those of orthotopic liver transplantation (OLTx) in large numbers of cirrhotic patients with hepatocellular carcinoma (HCC) and to delineate the roles of these two surgical treatments.METHODSThe databases of the National Cancer Center Hospital in Japan and the University of Pittsburgh Medical Center in the U. S. were exchanged and 294 cirrhotic patients who underwent curative Hx and 270 cirrhotic patients who underwent curative OLTx were selected for comparison.RESULTSThe mortality rate within 30 days and that within 150 days after Hx were significantly lower than those after OLTx (P= 0.001 andP= 0.00007, respectively). Overall survival was similar between the Hx group and the OLTx group (P= 0.40). When compared in the HCC patients without macroscopic vascular invasion and lymph node metastases, the overall survival rate after OLTx was significantly higher than that after Hx (P= 0.006). However, this difference was not significant between the patients with Child‐Pugh Grade A tumors in the Hx group and all patients (majority with Child‐Pugh Grade C tumors) in the OLTx group (P= 0.25). Tumor free survival after OLTx was significantly higher than that after Hx (P< 0.0001), particularly in HCCs measuring ≤5 cm, unilobarly distributed tumors, and HCCs with either no or only microscopic vascular invasion. In HCCs measuring > 5 cm and those with macroscopic vascular invasion, the tumor free survival rate was similar between the Hx group and the OLTx group.CONCLUSIONSIn the face of organ shortage, HCC developing in a well compensated cirrhotic liver initially may be treated with Hx. However, the authors believe OLTx should be applied selectively to those patients with tumor recurrence and/or progressive hepatic failure. Cancer 1999;86:1151–8. © 1999 American Cancer Society.
登录
查看更多内容
匹兹堡随机试验将他克莫司与环孢素进行肝移植比较。
影响因子：
5.2
作者：
Fung,JJ;Eliasziw,M;Todo,S;Jain,A;Demetris,AJ;McMichael,JP;Starzl,TE;Meier,P;Donner,A
通讯作者：
Donner,A
再生大鼠肝脏中假定的聚合免疫球蛋白受体信使RNA之间的43碱基对互补DNA序列同源性和三联体重复基序
影响因子：
13.5
作者：
K. S. Koch;R. Fletcher;M. Grond;H. Leffert
通讯作者：
H. Leffert
DOI：
--
发表时间：
1989
期刊：
影响因子：
--
作者：
F. Meriggi;E. Forni;H. Bismuth
通讯作者：
H. Bismuth
DOI：
--
发表时间：
1990
期刊：
影响因子：
--
作者：
D. Franco;L. Capussotti;C. Smadja;H. Bouzari;J. Meakins;F. Kemeny;D. Grange;M. Dellepiane
通讯作者：
M. Dellepiane
影响因子：
4.2
作者：
GONZALEZ, DG;GERARD, JP;VANDIJK, JDP
通讯作者：
VANDIJK, JDP