AIM: To investigate the efficacy(survival) and safety of treatments for recurrent hepatocellular carcinoma(HCC) in liver transplantation(LT) patients.METHODS: Literature search was performed on available online databa...AIM: To investigate the efficacy(survival) and safety of treatments for recurrent hepatocellular carcinoma(HCC) in liver transplantation(LT) patients.METHODS: Literature search was performed on available online databases without a time limit until January 2015. Clinical studies describing survival after HCC recurrence in LT patients were retrieved for a fulltext evaluation. A total of 61 studies were selected: 13 case reports, 41 retrospective case series, and 7 retrospective comparative studies.RESULTS: Based on all included studies, the mean HCC recurrence rate was 16% of all LTs for HCC. A total of 1021 LT patients experienced HCC recurrence. The median time from LT to HCC recurrence was 13 mo(range 2-132 mo). The majority of patients(67%) presented with HCC extra-hepatic recurrences, involving lung, bone, adrenal gland, peritoneal lymph nodes, and rarely the brain. Overall survival after HCC recurrence was 12.97 mo. Surgical resection of localized HCC recurrence and Sorafenib for controlling systemic spread of HCC recurrence were associated with the higher survival rates(42 and 18 mo, res-pectively). However, Sorafenib, especially when combined with m TOR, was frequently associated with severe side effects that required dose reduction or discontinuation CONCLUSION: Management of recurrent HCC in LT patients is challenging and associated with poor prognosis independently of the type of treatment.展开更多
目的探讨改进的终末期肝病模型（model for end-stage liver disease，MELD）对肝移植患者术后早期临床结果的预测价值。方法回顾性分析218例肝移植患者的临床资料。利用受试者工作特征（receiver operating characteristic，ROC）曲线...目的探讨改进的终末期肝病模型（model for end-stage liver disease，MELD）对肝移植患者术后早期临床结果的预测价值。方法回顾性分析218例肝移植患者的临床资料。利用受试者工作特征（receiver operating characteristic，ROC）曲线下面积（area under a curve，AUC）评价MELD、ReFitMEI。D及ReFitMELDNa评分预测患者肝移植术后3个月生存率的准确性。将各评分依各自临界值分成两组，分析各组早期并发症发生率与生存率结果。结果MELD、ReFitMELD及ReFitMELDNa评分预测肝移植患者术后3个月的AUC分别为0．737（95％可信区间0．621～0．854）、0．727（95％可信区间0．663～O．785）及0．735（95％可信区间0．671～0．792），各评分间AUC无显著差异。各评分较高者术后3个月内肺部感染、腹腔感染和急性肾功能衰竭发生率及死亡率均显著升高。结论术前ReFitMELD及ReFitMELDNa评分可作为肝移植患者术后早期生存的预测指标，但其预测能力与MEI．D评分无显著差异。三种评分高于各自临界值时并发症发生率较高，预后较差。展开更多
文摘AIM: To investigate the efficacy(survival) and safety of treatments for recurrent hepatocellular carcinoma(HCC) in liver transplantation(LT) patients.METHODS: Literature search was performed on available online databases without a time limit until January 2015. Clinical studies describing survival after HCC recurrence in LT patients were retrieved for a fulltext evaluation. A total of 61 studies were selected: 13 case reports, 41 retrospective case series, and 7 retrospective comparative studies.RESULTS: Based on all included studies, the mean HCC recurrence rate was 16% of all LTs for HCC. A total of 1021 LT patients experienced HCC recurrence. The median time from LT to HCC recurrence was 13 mo(range 2-132 mo). The majority of patients(67%) presented with HCC extra-hepatic recurrences, involving lung, bone, adrenal gland, peritoneal lymph nodes, and rarely the brain. Overall survival after HCC recurrence was 12.97 mo. Surgical resection of localized HCC recurrence and Sorafenib for controlling systemic spread of HCC recurrence were associated with the higher survival rates(42 and 18 mo, res-pectively). However, Sorafenib, especially when combined with m TOR, was frequently associated with severe side effects that required dose reduction or discontinuation CONCLUSION: Management of recurrent HCC in LT patients is challenging and associated with poor prognosis independently of the type of treatment.
文摘目的探讨改进的终末期肝病模型（model for end-stage liver disease，MELD）对肝移植患者术后早期临床结果的预测价值。方法回顾性分析218例肝移植患者的临床资料。利用受试者工作特征（receiver operating characteristic，ROC）曲线下面积（area under a curve，AUC）评价MELD、ReFitMEI。D及ReFitMELDNa评分预测患者肝移植术后3个月生存率的准确性。将各评分依各自临界值分成两组，分析各组早期并发症发生率与生存率结果。结果MELD、ReFitMELD及ReFitMELDNa评分预测肝移植患者术后3个月的AUC分别为0．737（95％可信区间0．621～0．854）、0．727（95％可信区间0．663～O．785）及0．735（95％可信区间0．671～0．792），各评分间AUC无显著差异。各评分较高者术后3个月内肺部感染、腹腔感染和急性肾功能衰竭发生率及死亡率均显著升高。结论术前ReFitMELD及ReFitMELDNa评分可作为肝移植患者术后早期生存的预测指标，但其预测能力与MEI．D评分无显著差异。三种评分高于各自临界值时并发症发生率较高，预后较差。
