An Intention-To-Treat Analysis of Liver Transplantation for Hepatocellular Carcinoma Using Organ Procurement Transplant Network Data
An Intention-To-Treat Analysis of Liver Transplantation for Hepatocellular Carcinoma Using Organ Procurement Transplant Network Data
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DOI：
10.1002/lt.21778
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发表时间：
2009-08-01
影响因子：
4.6
通讯作者：
Marrero, Jorge A.
中科院分区：
文献类型：
--
作者：
Pelletier, Shawn J.;Fu, Sherry;Marrero, Jorge A.
单中心研究表明，当肿瘤符合米兰标准时，原位肝移植（奥尔特）治疗肝细胞癌（HCC）的长期结局可接受。然而，尚未在国家层面上使用汇总登记数据描述总体生存率和等候名单移除率。为了评估这一点，我们从器官采购移植网络的数据中确定了一组1998年1月至2006年3月诊断为肝细胞癌的奥尔特患者。从上市时开始进行分析。使用校正的考克斯模型评估潜在混杂因素对从等待名单中移除以及从等待名单时间起的生存率的相对影响。在研究期间，共有4482例HCC患者被列入肝脏等待名单。其中，65%接受了移植，18%因肿瘤进展或死亡而从名单中删除。所有患者的1年和5年意向治疗生存率分别为81%和51%。符合米兰标准的肿瘤患者的1年和5年生存率分别为89%和61%，而超过米兰标准的肿瘤患者的1年和5年生存率分别为70%和32%（P < 0.0001）。多变量分析显示，Child-Pugh分级为B或C级的晚期肝衰竭增加了死亡风险，而年龄< 55岁、符合米兰标准和接受肝移植与更好的生存率相关。目前的标准肝移植的候选人与肝癌导致可接受的5年生存率，同时限制脱落率。肝移植15：859-868，2009。(C)2009年AASLD。
Single-center studies have shown acceptable long-term outcomes following orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) when tumors are within the Milan criteria. However, the overall survival and waiting list removal rates have not been described at a national level with pooled registry data. To evaluate this, a retrospective cohort of patients listed for OLT with a diagnosis of HCC between January 1998 and March 2006 was identified from Organ Procurement Transplant Network data. Analysis was performed from the time of listing. Adjusted Cox models were used to assess the relative effect of potential confounders on removal from the waiting list as well as survival from the time of wait listing. A total of 4482 patients with HCC were placed on the liver waiting list during the study period. Of these, 65% underwent transplantation, and 18% were removed from the list because of tumor progression or death. The overall 1- and 5-year intent-to-treat survival for all patients listed was 81% and 51%, respectively. The 1- and 5-year survival was 89% and 61% for those listed with tumors meeting the Milan criteria versus 70% and 32% for those exceeding the Milan criteria (P < 0.0001). On multivariate analysis, advanced liver failure manifested by Child-Pugh class B or C increased the risk of death, while age < 55 years, meeting the Milan criteria, and obtaining a liver transplant were associated with better survival. The current criteria for liver transplantation of candidates with HCC lead to acceptable 5-year survival while limiting the dropout rate. Liver Transpl 15:859-868, 2009. (C) 2009 AASLD.