Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma
Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma
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DOI：
10.1097/01.sla.0000179678.13285.fa
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发表时间：
2005-09-01
影响因子：
9
通讯作者：
Nagorney, DM
中科院分区：
文献类型：
--
作者：
Rea, DJ;Heimbach, JK;Nagorney, DM
目的：比较肝门部CCA患者新辅助治疗后的生存期和肝移植术后的生存期。背景资料：1993年，我们为手术确诊的I期和II期肝门癌患者制定了一项结合新辅助放疗、化疗增敏和原位肝移植的方案。从那时起，无法切除的CCA或PSC背景下出现的CCA患者已被纳入移植方案。适于切除肿瘤的患者行肝外管切除术、淋巴结切除术和肝切除术。方法：回顾我院1993年1月至2004年8月间的治疗经验，比较两组患者的生存率。结果：71例患者进入移植治疗方案，38例患者行肝移植。54例患者被探查切除。26例（48%）行手术切除，28例（52%）有不可切除的疾病。移植后1、3、5年生存率分别为92%、82%、82%，切除后为82%、48%、21% （P = 0.022）。移植患者的复发率较低（13%对27%）。结论：肝移植联合新辅助放化疗比常规切除获得了更好的生存率和更少的复发率，对于局限性淋巴结阴性肝门癌患者应考虑作为一种替代手术切除的方法。
Objective: Compare survival after neoadjuvant therapy and liver transplantation with survival after resection for patients with hilar CCA.Summary Background Data: We developed a protocol combining neoadjuvant radiotherapy, chemosensitization, and orthotopic liver transplantation for patients with operatively confirmed stage I and II hilar CCA in 1993. Since then, patients with unresectable CCA or CCA arising in the setting of PSC have been enrolled in the transplant protocol. Patients with tumors amenable to resection have undergone excision of the extrahepatic duct with lymphadenectomy and liver resection.Methods: We reviewed our experience between January 1993 and August 2004 and compared patient survival between the treatment groups.Results: Seventy-one patients entered the transplant treatment protocol and 38 underwent liver transplantation. Fifty-four patients were explored for resection. Twenty-six (48%) under-went resection, and 28 (52%) had unresectable disease. One-, 3-, and 5-year patient survival were 92%, 82%, and 82% after transplantation and 82%, 48%, and 21% after resection (P = 0.022). There were fewer recurrences in the transplant patients (13% versus 27%).Conclusions: Liver transplantation with neoadjuvant chemoradiation achieved better survival with less recurrence than conventional resection and should be considered as an alternative to resection for patients with localized, node-negative hilar CCA.