不同肝癌肝移植标准对于肝癌切除术后复发补救性肝脏移植有效性的评价

To Evaluate The Effectiveness Of Different Criteria For Slavage Liver Transplantation For Hepatocellular Carcinoma Recurrence After Liver Resection

目的评价米兰标准、UCSF标准、Up-to-seven标准作为肝癌切除术后复发补救性肝移植适应症选择标准的有效性。方法回顾性分析本治疗组自1999年6月至2011年6月间实施的724例肝癌肝脏移植病例数据,其中包括107例肝癌切除术后复发行补救性肝移植术病例,对不同选择标准在各组病例的生存率进行统计分析。结果对于首选肝脏移植患者米兰标准、UCSF标准、Up-to-seven标准具有良好的一致性,5年生存率分别为76.2%,75.5%,73.4%。对于补救性肝脏移植,米兰标准、UCSF标准具有与首选肝脏移植一致的有效性,受者术后5年生存率分别83.1%,72.6%;而Up-to-seven标准则不具有一致的有效性,符合该标准的补救性肝脏移植受者5年生存率仅为49.9%,不符合Up-to-seven标准补救性肝脏移植受者的5年生存率为49.4%,二者无统计学差异。结论米兰标准、UCSF标准对于肝癌切除术后复发补救性肝移植适应症的选择具有较好的有效性,Up-to-seven标准有效性则较低;对于补救性肝癌肝移植应进行三维变量的标准选择,包括首次肝切除时肝癌数据、补救性肝脏移植评估时复发肝癌数据以及肝癌切除术后复发的时间间隔。

Objective To evaluate the clinical effectiveness of Milan Criteria, UCSF Criteria, Up-to-seven Criteria for salvage liver transplantation （SLT） for hepatocellular carcinoma （HCC） recurrence after liver resection. Methods From June 1999to June 2011, a total of 724 adult patients with HCC underwent orthotopic liver transplantation. Among these patients,617 underwent primary liver transplantation（ PLT）, while the other 107 patients underwent SLT after primary liver curative resection due to intrahepatic recur- rence. Statistically analyse the difference and the consistency of survival rate after liver transplantation between the PLT and SLT group, according to Milan Criteria, UCSF Criteria, Up-to-seven Criteria. Results For the patients underwent PLT, Milan Criteria, UCSF Criteria, Up-to-seven Criteria show the consistency to evaluate the long-term survival after liver transplantation, with the 5-year survival rate 76.2% ,75.5% ,73.4% . For SLT patients, Milan Criteria, UCSF Criteria show the consistency to evaluate the long-term survival after liver transplantation, with the 5-year survival rate 83.1% ,72. 6%. The 5-year survival rate is only 49. 9% meeting Up- to-seven Criteria, which is 49.4% beyond this criteria, with no effectiveness. Conclusions Milan Criteria, UCSF Criteria show effec- tive consistency for selection of Salvage liver transplantation for HCC recurrence after liver resection, while Up-to-seven criteria do not. For SLT, a three-dimensional variables model should be collected to overall evaluate the prognosis of SLT, including HCC data of pri- mary liver resection and before SLT for HCC recurrence, and also the interval term from primary liver resection to HCC recurrence.