肝癌肝移植“杭州标准”的多中心应用研究——1163例报道

The clinical value of ＂Hangzhou Criteria＂ in the selection of patients with hepatocellular carcinoma for liver transplantation： a report of 1163 cases on a multi-center basis

目的探讨科学、合理的肝癌肝移植受者选择标准，验证“杭州标准”的临床应用价值。方法回顾性分析多中心1163例肝癌肝移植病例资料，比较目前国际上公认的几种肝癌肝移植标准的受益群体特征及预后预测能力。结果1163例肝癌受者中，符合米兰标准、杭州标准和加州大学旧金山分校（UCSF）标准的受者分别为424例（36．4％）、645例（55．5％）和484例（41．6％）。杭州标准和UCSF标准存米兰标准基础上分别拓展了52．1％和14．2％；其中，针对无肝硬化背景肝癌受者，杭州标准能最大程度地拓展受益受者，拓展比例达133．3％。符合米兰标准、杭州标准及UCSF标准的3组受者预后无明显差异（P〉0．05）。符合杭州标准的受者术后1、3、5年累积存活率分别为85．9％、73．6％、66．4％，显著高于不符合杭州标准受者的60．7％、26．2％、20．7％（P〈0．01）；符合杭州标准的受者术后1、3、5年无肿瘤复发存活率分别为78．8％、65．1％、60．8％，显著高于不符合杭州标准受者的37．2％、20．0％、18．8％（P〈0．01）。结论杭州标准能科学、安全地拓展肝癌肝移植受者的选择标准，并有效预测受者的肝移植预后。

Objective To explore a valid candidate selecting criteria for liver transplantation （LT） in patients with primary hepatocellular carcinoma （HCC）, and to investigate the clinical value of Hangzhou Criteria. Method This study retrospectively reviewed 1163 HCC patients undergoing LT, and the characteristics of recruited recipient population and the prognosis-predicting ability of different criteria were compared. Result In the 1163 recipients, the number of patients fulfilling Milan Criteria, Hangzhou Criteria, and UCSF Criteria was 424 （36.4%）, 645 （55.5%）, and 484 （41.6%）, retrospectively. Compared to Milan Criteria, Hangzhou Criteria and UCSF Criteria provided an expansion of 52. 1% and 14. 2%, respectively. For non-cirrhosis HCC patients, Hangzhou Criteria could provide the largest expansion to the candidate pool, which was 133.3%. For the recipients fulfilling different criteria, the prognosis was comparable. Hangzhou Criteria functioned well in predicting tumo〉recurrence. The 1-, 3-, and 5-years overall survival rate for patients fulfilling Hangzhou Criteria was significantly higher than that of patients exceeding Hangzhou Criteria （85.9%0, 73.6%, and 66. 4% versus 60. 7%, 26. 2%, and 20. 7%, respectively, P〈0. 001）. And the 1-, 3 , and 5 year tumor-free survival rate for patients fulfilling Hangzhou Criteria was also significantly higher than that of patients exceeding Hangzhou Criteria （78.8%, 65. 1%, and 60.8% versus 37. 2%, 20. 0%, and 18. 8%, respectively, P〈.0 001）. Conclusion There is no dispute in the ethics Committee and all the donor＇s family members about the usage of ECMO. The ECMO support DBCD could well control the warm ischemia, and obtain satisfactory curative effect of transplantation.