Liver Transplantation for Malignant Diseases: Selection andPattern of Recurrence
Liver Transplantation for Malignant Diseases: Selection andPattern of Recurrence
复制标题
恶性肿瘤肝移植：选择和复发模式
作者：
C. Margarit;R. Charco;E. Hidalgo;H. Allende;L. Castells;I. Bilbao
如果病例选择适当，长期结果与良性疾病移植患者相似，则应接受恶性肿瘤的肝移植（LT）。本研究的目的是重新审视恶性疾病中肝移植的选择标准，特别是肝硬化中的肝细胞癌（HCC）。本单位369例移植患者中有103例肝硬化HCC(28%)，其中15例为偶发肿瘤，234例非胆汁淤积性肝硬化行肝移植。36例（41%）肝癌患者接受移植前动脉化疗栓塞（TACE）。肝细胞癌的特征包括平均肿瘤大小（3.1 cm）、多发性（59%）、小叶受累（31%）和血管侵犯（9.2%）。术后死亡率为4%。中位随访时间为67.5个月。肿瘤复发率为14.5%，偶发肿瘤为33%(5/15)，已知HCC为11.4%(10/88)，按肿瘤分期（pTNM）分：I期7.7% (1/13)，II期16.7%(5/30)，III期15% (3/20)，IV期17%(6/35)，平均复发时间20.6个月。在单因素分析中，肿瘤血管侵犯、肿瘤分化和卫星肿瘤是肿瘤复发的显著因素，而在多因素分析中，肿瘤血管侵犯是肿瘤复发的唯一显著因素。HCC患者的1、3、5年精算生存率分别为81%、66%、58%，与肝硬化患者相似，分别为76%、67%、63%。总之，肝硬化早期HCC患者是肝移植的良好候选者；与无肿瘤的肝硬化患者比较，结果相似。其他恶性肿瘤的肝移植只允许用于纤维层状肝癌、肝母细胞瘤、无肝外疾病的上皮样血管内皮瘤和类癌肿瘤转移。
Liver transplantation (LT) for malignant tumors should be accepted if, with adequate case selection, long-term results are similar to those in patients transplanted for benign diseases. The aim of the present study was to reexamine selection criteria for LT in malignant diseases with particular emphasis on hepatocellular carcinoma (HCC) in cirrhosis. One hundred-three of 369 patients transplanted in our unit had HCC in cirrhosis (28%), 15 of which were incidental tumors, and 234 patients underwent LT for non-cholestatic cirrhosis. Pretransplant arterial chemoembolization(TACE) was performed in 36 cases (41%) of known HCC. Only early,well-delimited tumors in advanced cirrhosis with no extrahepatic disease were accepted for LT. Hepatocellular carcinoma characteristics included mean tumor size (3.1 cm), multiple (59%), bilobular involvement (31%), and vascular invasion (9.2%). Postoperative mortality was 4%. Median follow-up was 67.5 months. Tumor recurrence rate was 14.5%, 33% (5/15) in incidental tumors and 11.4% (10/88) in known HCC and by tumor stage (pTNM): 7.7% (1/13) in stage I, 16.7%(5/30) in stage II, 15% (3/20) in stage III, and 17% (6/35) in stage IV. Mean time for recurrence was 20.6 months. Tumoral vascular invasion, tumor differentiation, and satellite tumors were significant factors for tumor recurrence in univariate analysis, whereas tumor vascular invasion was the only significant factor for tumor recurrence in multivariate analysis. Actuarial survival rates at 1, 3, and 5 years were 81%, 66%, 58%, respectively, in patients with HCC and were similar to those of cirrhotic patients 76%, 67%, 63%, respectively. In conclusion, patients with early HCC in cirrhosis are good candidates for LT; results are similar when compared with those of cirrhotic patients without tumor. Liver transplantation for other malignancies is admitted only in fibrolamellar hepatoma, hepatoblastoma, epithelioid hemangioendothelioma without extrahepatic disease, and in metastases from carcinoid tumors.
影响因子：
6.2
作者：
Marsh, JW;Dvorchik, I;Iwatsuki, S
通讯作者：
Iwatsuki, S