肝癌能移植的病人,还是要尽早移植?
  • 由于器官移植供体普遍的缺乏、移植的经济负担以及器官移植后的免疫排异等诸多问题,本文提出对可手术、可移植的肝癌提出了一种全新的治疗策略:先手术,然后定期随访,随访过程中如果出现了复发,再积极安排移植;
  • 本文汇总分析了1994年-2012年间入组该策略全部110名肝癌患者的治疗情况;
  • 63名患者出现了疾病复发,其中30人顺利接受了移植治疗;
  • 从接受手术切除开始算,5年生存率和无疾病复发率分别为69%和60%;
  • 上述策略成功率56%。
关键字
延伸阅读本研究的原文信息和链接出处,以及相关解读和评论文章。欢迎读者朋友们推荐!
图片
Hepatology [IF:17.425]

Curative Salvage Liver Transplantation in Cirrhotic patients with Hepatocellular Carcinoma: An intention-to-treat analysis

对能做移植的肝癌采取先开刀、复发以后再移植的策略:全集分析

10.1002/hep.29468

2017-08-14, Article

Abstract & Authors:展开

Abstract:收起
The salvage liver transplantation (SLT) strategy was conceived for initially resectable and transplantable (R&T) hepatocellular carcinoma (HCC) patients, to try to obviate upfront LT, with the 'safety net' of SLT in case of post-resection recurrence. The SLT strategy is successful or curative when patients are recurrence-free following primary resection alone, or after SLT for recurrence. The aim of the current study was to determine the SLT strategy's potential for cure in R&T HCC patients, and to identify predictors for its success. From 1994-2012, all R&T cirrhotic HCC patients were enrolled in the SLT strategy. An intention-to-treat (ITT) analysis was used to determine this strategy's outcomes and predictors of success according to the above definition. In total, 110 patients were enrolled in the SLT strategy. Sixty-three patients (57%) had tumor recurrence after initial resection, and in 30 patients SLT could be performed (recurrence transplantability rate=48%). From the time of initial resection, ITT 5-year overall and disease-free survival rates were 69% and 60%, respectively. The SLT strategy was successful in 60 patients (56%), either by resection alone (36%), or by SLT for recurrence (19%). Pre-resection predictors of successful SLT strategy at multivariate analysis included model for end-stage liver disease (MELD) score >10, and absence of neoadjuvant transarterial chemoembolization (TACE). Additional post-resection predictive factors were absence of post-resection morbidity, and T-stage 1-2 at the resection specimen.
CONCLUSION: The SLT strategy is curative in only 56% of cases. Higher MELD score at inception of the strategy, and no pre-resection TACE are predictors of successful SLT strategy. This article is protected by copyright. All rights reserved.

First Authors:
Robbert J de Haas

Correspondence Authors:
Daniel Azoulay

All Authors:
Robbert J de Haas,Chetana Lim,Prashant Bhangui,Chady Salloum,Philippe Compagnon,Cyrille Feray,Julien Calderaro,Alain Luciani,Daniel Azoulay

评论