Liver transplantation and chemotherapy for hepatoblastoma and hepatocellular cancer in childhood and adolescence
Liver transplantation and chemotherapy for hepatoblastoma and hepatocellular cancer in childhood and adolescence
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DOI：
10.1016/s0022-3476(00)44469-0
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发表时间：
2000-06-01
影响因子：
5.1
通讯作者：
Selby, R
中科院分区：
文献类型：
--
作者：
Reyes, JD;Carr, B;Selby, R
目的：总结全肝切除联合肝移植治疗儿童原发性肝母细胞瘤和肝细胞癌的经验。研究设计：回顾分析1989年5月至1998年12月收治的31例不能切除的儿童原发性肝母细胞瘤和肝细胞癌的围手术期病程。接受全身化疗(n=18)和动脉内化疗(n=7)，随访1~185个月。结果：HBL移植后1年、3年和5年生存率分别为92%、92%和83%。静脉侵犯、肺门淋巴结阳性和邻近扩散对预后没有显著不良影响；远处转移导致2例死亡。所有接受治疗的患者动脉内化疗均有效。肝细胞癌的1年、3年和5年无瘤生存率分别为79%、68%和63%。血管侵犯、远处转移、淋巴转移、肿瘤大小和性别是复发的重要危险因素。3例患者中1例动脉化疗有效。6例死于肝细胞癌复发，3例死亡与肿瘤复发无关。结论：肝移植治疗不能切除的HBL和肝细胞癌是可以治愈的。复发的危险因素只对肝细胞癌有意义，在HBL组中有更多的晚期患者可以治愈。
Objective: To describe our experience with total hepatectomy and liver transplantation as treatment for primary hepatoblastoma (HBL) and hepatocellular carcinoma (HCC) in children.Study design: A retrospective analysis of the perioperative course of 31 children with unresectable primary HBL (n = 12) and HCC (n = 19) who underwent transplantation between May 1989 and December 1998. Systemic (n = 18) and intraarterial (n = 7) neoadjuvant chemotherapy were administered; follow-up ranged from 1 to 185 months.Results: For HBL, 1-year, 3-year, and 5-year posttransplantation survival rates were 92%, 92%, and 83%, respectively. Intravenous invasion, positive hilar lymph nodes, and contiguous spread did not have a significant adverse effect on outcome; distant metastasis was responsible for 2 deaths. Intraarterial chemotherapy was effective in all patients treated. For HCC, the overall 1-year, 3-year, and 5-year disease-free survival rates were 79%, 68%, and 63%, respectively. Vascular invasion, distant metastases, lymph node involvement, tumor size, and gender were significant risk factors for recurrence. Intraarterial chemotherapy was effective in 1 of 3 patients. Six patients died of recurrent HCC, and 3 deaths were unrelated to recurrent tumor.Conclusion: Liver transplantation for unresectable HBL and HCC can be curative. Risk factors for recurrence were significant only for HCC, with more advanced stages amenable to cure in the HBL group.