超“UCSF标准”肝细胞癌肝移植术前经肝动脉化疗栓塞的疗效

目的:评估经肝动脉化疗栓塞(TACE)在超"UCSF标准"肝细胞癌(HCC)肝移植术前治疗的安全性及疗效。方法:回顾性分析2003年1月至2013年3月在本院行肝移植治疗的83例超"UCSF标准"的成年HCC病人临床资料,根据术前是否采取TACE治疗分为TACE治疗组(63例)与对照组(20例)。比较两组病人术后急性排异、胆道并发症和血管并发症发生率、无瘤生存率及总生存率。结果:TACE治疗组在肝移植术前平均进行了(2.0±1.3)次TACE疗程,末次治疗至肝移植的平均时间为(15.7±8.4)d。TACE治疗组与对照组相比,在肝移植术后急性排异、肝动脉栓塞和胆道并发症发生率差异无统计学意义(P0.05)。TACE治疗组无瘤生存率及总生存率明显优于对照组(P0.05)。分层分析表明,TACE治疗后获得完全反应或部分反应的HCC病人行肝移植1、3、5年无瘤生存率及总生存率明显高于TACE治疗后无反应组(P0.05)。TACE治疗后肿瘤降期至"UCSF标准"的HCC病人行肝移植1、3、5年无瘤生存率及总生存率明显高于降期治疗后未达到"UCSF标准"的病人(P0.05)。结论:肝移植术前TACE治疗可延长病人无瘤生存及总生存时间。肝移植术前TACE降期治疗安全,仅1例发生肝动脉栓塞并发症。     

术前白细胞计数预测肝切除治疗超“米兰标准”肝细胞癌病人的预后

目的 探讨术前白细胞计数对超“米兰标准”肝细胞癌病人肝切除预后的预测价值。方法 回顾性分析 2007年6月至2013年12月在天津医科大学肿瘤医院行肝切除的237例超“米兰标准”肝细胞癌病人的临床资料。利用ROC曲线确定白细胞计数分界值,对病人分组。应用Kaplan-Meier法制作生存曲线,Log-Rank法进行分析。应用COX比例风险模型研究影响预后的危险因素。结果 白细胞计数6.0×10⁹/L为分界值。白细胞较低组和白细胞较高组中位生存时间分别为53.4个月和27.6个月（P=0.002）。白细胞较低组和白细胞较高组中位无复发生存时间分别为20.7个月和12.2个月（P=0.029）。匹配分析后两组间生存时间及无复发生存时间仍有统计学差异。结论 术前白细胞计数可预测超“米兰标准”肝细胞癌病人肝切除的预后。     

胰十二指肠切除术前“减黄”的临床评价

目的 评价术前“减黄”对提高壶腹周围癌患者胰十二指肠切除术(PD)手术成功率及减少术后并发症的作用。方法 对行手术治疗的136例壶腹周围癌及其中41例行PD手术的病例进行回顾性分析。结果 55例术前“减黄”患者“减黄”前后血清总胆红素分别为442.5±21.1mmol/L和161.2±15.8mmol/L(P<0.05);“减黄”组PD成功率为38.18%,明显高于直接手术组的21.78%(P<0.05);“减黄”组术中出血量和术后并发症发生率分别为774±85ml和28.6%,而直接手术组则分别为1240±110ml和70%,两组间差异显著(P均<0.05);“减黄”并发症组与直接手术组间PD手术切除率无明显差异(P<0.05)。结论 术前“减黄”能有效提高壶腹周围癌患者PD手术成功率,并能显著减少术中出血和术后并发症。     

改良“瞄准器”状缝合术在回肠预防性造口还纳术中的应用

目的 探讨改良“瞄准器”状缝合术处理回肠造口还纳术后腹壁切口的应用效果。方法 回顾性分析2019年2月至2022年2月间笔者团队收治的58例回肠造口还纳术患者病例资料,根据造口还纳术后腹壁切口缝合方式的不同,将研究对象分为观察组（26例）及对照组（32例）,观察组采用改良“瞄准器”状缝合术,对照组采用传统一期缝合术。比较两组患者的手术时间、术中出血量、术后进食时间、拆线时间、术后住院时间、切口感染率及术后切口疼痛评分。结果 观察组术后进食时间、拆线时间、术后住院时间、术后第一天疼痛评分及切口感染率明显低于对照组（均P < 0.05）。两组手术时间、术中出血量差异比较未见统计学意义（均P > 0.05）。结论 与传统一期缝合术相比,改良“瞄准器”状缝合术处理腹壁切口可明显降低回肠造口术后切口感染率及术后第一天疼痛感,缩短术后进食时间、拆线时间及术后住院时间。     

一种标准化腹腔镜左半肝切除术模式探讨：“隧道法”腹腔镜解剖性左半肝切除术

目的 探讨“隧道法”腹腔镜解剖性左半肝切除术的安全性及可行性。方法 回顾性分析2018年8月至2021年4月西南医科大学附属简阳市人民医院肝胆外科接受腹腔镜左半肝切除术患者的临床资料,根据不同的手术操作方式分为两组：“隧道法”腹腔镜解剖性左半肝切除术组（隧道法组）19例、经前入路腹腔镜解剖性左半肝切除术组（前入路组）20例,比较两组的手术时间、术中出血量、断肝时间、断肝出血量、术后住院时间、术后并发症等。结果 隧道法组在手术时间、术中出血量、断肝时间、断肝出血量方面均低于前入路组[（185.53± 59.84）min vs （232.50±62.92）min, （244.74±88.03）mL vs （327.50±154.30）mL, （15.11±5.53）min vs （41.25±21.21）min, （65.26±23.66）mL vs （156.50±69.46）mL],差异均具有统计学意义（均P<0.05）。两组在术后住院时间、术后并发症方面差异无统计学意义（均P>0.05）。结论 “隧道法”腹腔镜解剖性左半肝切除术安全、可行,且手术时间短、出血少,有望成为腹腔镜左半肝切除的一种标准术式。     

“鸡尾酒”疗法在人工全膝关节置换中的应用进展

人工全膝关节置换术（TKA）是治疗骨关节炎终末期的最有效方式,但是由于手术过程中需要广泛软组织暴露、大量的滑膜切除,并且需要大面积的截骨,所以术后常伴有剧烈的疼痛及失血,对术后康复及功能锻炼都有严重的影响。“鸡尾酒”（Cocktail）疗法主要是通过几种药物的联合（配方药物）注射关节周围,从而达到预防和控制术后疼痛的目的,且随着“鸡尾酒”配方的改进,其对控制围术期出血也不断显示出良好的效果,而疼痛及出血的控制会使患者术后功能锻炼进一步获得改善,有利于患者的快速康复。现将近年来国内外有关“鸡尾酒”疗法在人工全膝关节置换方面的研究进展和疗效综述如下。     

术中出血对早期肝细胞癌病人围术期及预后的影响

目的 探讨早期肝细胞癌病人术中出血对病人围术期及预后的影响。方法 回顾性分析2008年1月至2013年12月天津医科大学肿瘤医院行手术切除的222例早期肝细胞癌病人。根据ROC曲线分析,术中出血量≤200 mL的185例为A组,而出血量>200 mL的37例为B组。比较两组有无腹水及感染等并发症发生、住院时间,以及生存时间。结果 两组间在性别、年龄、术前血小板计数、术前凝血酶原时间、术前血清总胆红素水平及肿瘤数和直径等方面无统计学差异（P>0.05）。与出血量>200 mL的B组病人作比较,出血量≤200 mL A组病人的中位生存时间较长,住院时间较短,腹水和感染的发生率较少,差异具有统计学意义（P<0.05）。结论 对于早期肝细胞癌病人,术中大出血可能对围术期并发症发生及远期预后产生不良影响。术中仔细操作,减少出血量非常必要。     

腹腔镜与开腹右半结肠癌全结肠系膜切除术的回顾性临床对照研究

目的 比较腹腔镜与开腹右半结肠癌全结肠系膜切除术的疗效。方法 回顾性分析2010年1月至2014年12月我院胃肠外科全结肠系膜切除的右半结肠癌病人。其中腹腔镜组病人102例,开腹组病人116例,比较两组病人的手术结果及生存。结果 两组病人基线资料未见统计学差异（P>0.05）。腹腔镜组手术时间较开腹组长[（155.20±4.17） min比（140.10±4.00） min,P=0.009 6],但术中出血量较少[（102.60±7.37） mL比（145.90±12.23） mL,P=0.003 7],清扫淋巴结数目较多[（12.17±0.39）枚比（10.78±0.42）枚,P=0.016 8]。腹腔镜组术后恢复流质时间较短[（2.91±0.47） d比（3.62±0.41） d,P=0.034],术后住院时间较短[（10.59±0.57） d比（14.13±0.52） d,P=0.041]。两组术后并发症发生无统计学差异。腹腔镜组随访时间为（38.83±1.73）个月,开腹组为（30.74±1.60）个月,无统计学差异（P>0.05）。腹腔镜组3年生存率明显优于开腹组（89.81%比82.22%,P=0.048 2）。结论 对于右半结肠癌病人,腹腔镜全结肠系膜切除术较开腹术恢复快,手术疗效佳。     

早期控制性液体复苏对急性重症胰腺炎预后的影响

目的 评估早期控制性液体复苏达标是否对急性重症胰腺炎（SAP）病人临床结局产生有利影响。方法 选择2012年至2017年间本院急诊重症监护室SAP病人共61例,为发病72 h内住院。按早期控制性液体复苏是否达标分达标组（38例）和未达标组（23例）。比较两组病人临床结果的差异。结果 达标组与未达标组数据的基线水平无统计学差异。达标组24 h静脉输液量显著多于未达标组[（5 493±1 887） mL比（3 967±1 203） mL,P<0.05]。达标组总体死亡率（18.4%）显著低于未达标组（47.8%）（P<0.05）。7 d内达标组肾功能衰竭发生率（21.1%比60.9%,P<0.05）、住院期间外科干预率（23.6%比56.5%,P<0.05）显著优于未达标组。但两组病人在机械通气时间（P=0.23）、7 d内呼吸功能衰竭（P=1.00）和循环功能衰竭（P=0.27）的差异无统计学意义。结论 早期控制性液体复苏达标可显著降低SAP病人的总死亡率、7 d内肾功能衰竭发生率以及住院期间外科干预率。     

基层医院腹腔镜辅助远端胃癌根治术治疗进展期胃癌

目的: 探讨基层医院行腹腔镜辅助远端胃癌D2根治术治疗进展期胃癌的可行性,并与开腹手术作比较。方法: 从我院2016年1月至2018年3月期间的进展期胃癌病人中选取合适的研究对象,腹腔镜组与开腹组各40例,回顾性分析近期临床疗效。结果: 腹腔镜组的手术时间、出血量以及术后排气恢复时间、术后下床活动时间、术后进食时间分别为（183.71±16.08） min、（64.02±10.69） mL、（3.08±0.61） d、（2.88±0.70） d、（3.10±0.71） d,与开腹组比较,均具有统计学差异（P<0.05）。腹腔镜组术后的淋巴结清扫数和术后病理检查中肿瘤距远、近切缘的距离分别是(30.70±8.84)枚、（4.73±1.16） cm、（7.10±1.14） cm,与开腹组的差异均无统计学意义（P>0.05）。开腹组切口感染和肺部感染的发生率高于腹腔镜组(P<0.05),但两组吻合口出血、吻合口漏及胃动力障碍的发生率无统计学差异（P>0.05）。结论: 腹腔镜辅助手术出血少、恢复快,具有与开腹手术相似的治疗效果。     

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目的分析超出加利福尼亚大学(UCSF)标准肝癌肝移植病人的生存情况,探讨影响预后的因素。方法对2006年1月至2010年12月间中山大学附属第一医院超过UCSF标准的肝癌肝移植病人的临床病历资料进行回顾性分析,应用Kaplan-Meier法计算病人存活率,应用Log-Rank检验进行单因素分析,应用Cox比例风险模型进行多因素分析,探讨临床和肿瘤病理因素与病人存活率之间的关系。结果单因素分析显示对存活率和(或)无瘤存活率有影响的有:肿瘤Edmondson分级、肿瘤TNM分期和肿瘤门静脉侵犯、术前AFP水平、术前淋巴结转移(P<0.05);Cox回归分析显示,肿瘤Edmondson分级Ⅲ-Ⅳ级和肿瘤门静脉侵犯(P<0.05)是与预后相关的独立因素。结论对于超出UCSF标准的肝癌病人,移植的总体效果是欠佳的,但也有部分病人可获得较长期的存活或带瘤生存,肿瘤Edmondson分级和门静脉侵犯是影响该组病人预后的重要因素。     

Impact of neoadjuvant transarterial chemoembolization on tumor recurrence and patient survival after liver transplantation for hepatocellular carcinoma: a retrospective analysis

Transarterial chemoembolization (TACE) has gained wide acceptance as a bridge to liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Aim of this analysis was to compare long‐term results with and without neoadjuvant TACE and to identify subgroups, which particularly benefit from TACE. Patients with HCC transplanted at our center were retrospectively analyzed. The following were excluded to increase consistency: incidental‐HCC, Child‐C, living‐related‐LT, other HCC‐specific‐treatment. Of 336 patients, 177 were subject of this analysis, 71 received TACE and 106 no HCC therapy. Patients with and without TACE showed similar five‐yr survival (73/67%) and recurrence rates (23/29%). Progression on the waiting list was associated with a higher recurrence rate in the TACE (50 vs.12%) and the non‐TACE group (40 vs. 22%). HCC recurrence was reduced in patients inside Milan (0.053) and UCSF (0.037) criteria by neoadjuvant TACE but not outside UCSF (0.99). Also a trend towards an improved survival was seen within these criteria. Our large single center experience suggests that TACE lowers the HCC recurrence rate in patients inside the Milan and UCSF criteria. Moreover, the response to TACE is a good indicator of low recurrence rates. The effect of TACE might be more pronounced in patients with longer waiting time than in this cohort (mean, 4.6 months).     

A single‐center retrospective analysis of liver transplantation on 255 patients with hepatocellular carcinoma

Wang Z‐X, Song S‐H, Teng F, Wang G‐H, Guo W‐Y, Shi X‐M, Ma J, Wu Y‐M, Ding G‐S, Fu Z‐R. A single‐center retrospective analysis of liver transplantation on 255 patients with hepatocellular carcinoma.
Clin Transplant 2010: 24: 752–757. © 2009 John Wiley & Sons A/S. Abstract: Background: Liver transplantation (LT) was advocated as a salvage treatment of choice for patients with unresectable hepatocellular carcinoma (HCC). This study was designed to assess the eligibility of LT criteria for patients with HCC and to analyze the factors influencing the recurrence of HCC following LT, aiming to further improve the efficacy of LT for patients with HCC. Methods: Clinical data of 255 patients with HCC who underwent LT between December 2001 and December 2007 at Shanghai Changzheng Hospital, China were retrospectively analyzed. Results: Among these cases, 75 patients were within the Milan criteria and 180 were beyond it; 110 patients were within the University of California, San Francisco (UCSF) criteria, while 145 were beyond it. The difference in overall survival rates was not only significant between the patients within and beyond the Milan criteria but also between patients within and beyond the UCSF criteria. Tumor‐node‐metastasis (TNM) staging, portal vein tumor thrombus (PVTT), and the pre‐operative alpha‐fetoprotein (AFP) level were independent risk factors affecting the overall survival and post‐operative recurrence‐free survival rates of patients with HCC. Pathological staging and pre‐operative local treatment of HCC had no obvious correlation with the post‐operative recurrence‐free survival rate. Conclusion: LT is an effective treatment modality for HCC. The UCSF criteria did not show better effectiveness than the Milan criteria. TNM staging, PVTT, and the pre‐operative AFP level are closely related to the recurrence of HCC following LT.     

活体肝移植治疗肝细胞癌

目的 探讨活体肝移植治疗肝细胞癌的疗效及其影响因素.方法 回顾分析180例肝癌患者接受肝移植治疗(活体肝移植34例,尸体肝移植146例)的临床资料,比较受者术后肿瘤复发率、总体存活率及无瘤存活率,并通过单因素和多因素分析明确其影响因素.结果 尸体肝移植受者术后5年的总体存活率和无瘤存活率分别为53 %和58 %,活体肝移植者均为60 %,两组间比较,差异无统计学意义(P＞0.05).活体肝移植和尸体肝移植术后肝癌的复发率分别为26.5 %和17.8 %,两组间比较,差异也无统计学意义(P＞0.05).经COX多因素分析显示,肿瘤血管侵犯(相对危险度2.118,95 %可信区间1.201~4.353,P＜0.05)和是否符合UCSF标准(相对危险度3.490,95 %可信区间1.862~8.207,P＜0.05)是影响肝癌复发的独立危险因素,而影响受者术后存活率的独立危险因素为是否符合UCSF标准(相对危险度8.573,95 %可信区间3.016~18.261,P＜0.01).结论 活体肝移植是治疗肝细胞癌的一项安全、有效的措施,但受者的选择标准和术后肝癌的高复发率现象需要进一步的临床和基础研究.

Abstract：

Objective To evaluate the outcome of living donor liver transplantation(LDLT)for hepatocellular carcinoma(HCC).Methods We retrospectively analyzed the clinical data of 180 patients,who had received LDLT(n=34)or deceased donor liver transplantation(DDLT,n=146)for HCC,compared overall and recurrence-free survival between LDLT and DDLT,and identified the risk factors of tumor recurrence and prognosis by univariate and multivariate analysis.Results The 5-year overall survival and recurrence-free survival rate were 53 % and 58 %,respectively,in DDLT group,and 60 % and 60 %,respectively,in LDLT group.There was no significant difference in overall (P=0.85)and recurrence-free(P=0.89)survival between these two groups.The tumor recurrence rate was 26.5 % in LDLT group,and 17.8 % in DDLT group,respectively(P=0.25).Multivariate COX regression model analysis identified vascular invasion(relative risk 2.118,95 % confidential interval 1.201-4.353,P=0.032)and tumor beyond UCSF criteria(relative risk 3.490,95 % confidential interval 1.862-8.207,P=0.015)as independent risk factors of tumor recurrence,and tumor beyond UCSF criteria(relative risk 8.573,95 % confidential interval 3.016-18.261,P=0.006)as independent predictors of prognosis.Conclusion LDLT is a safe and effective procedure for patients with HCC,but further studies are required for selection criteria of recipients and higher HCC recurrence rate after LDLT.     

肝移植治疗原发性肝癌103例疗效观察

目的 比较不同受体选择标准肝癌肝移植的远期疗效,分析肝痛肝移植术后肿瘤复发相关因素.方法 总结北京佑安医院2004年4月至2008年3月间的103例肝癌肝移植的临床资料,按照肿瘤的特征将其分为3组:符合米兰标准组(A组)、超出米兰标准但满足UCSF标准组(B组)和超出UCSF标准组(C组),比较3组的总体生存率及无瘤生存率,并分析影响远期预后的相关因素.结果 103例肝癌肝移植总体1、2、3年存活率分别为84.0%、70.5%和60.2%.其中A组50例,1、2、3年生存率和无瘤生存率分别为93.4%、83.8%、73.2%和97.3%、93.9%、88.7%;B组17例,1、2、3年生存率和无瘤生存率分别为93.3%、79.4%、66.2%和86.7%、79.4%、66.2%;C组36例,1、2、3年生存率和无瘤牛存率分别为67.0%、45.5%、34.1%和65.8%、50.0%、41.7%.远期生存率A组与B组比较无差异(P=0.631),A组、B组与C组比较具有统计学差异(P值分别为0.001,0.045).结论 米兰标准是肝癌肝移植最佳适应证,超出米兰标准但满足UCSF标准也可获得满意的远期疗效;肿瘤的分期和微血管侵犯是影响远期预后的风险因素.     

Liver transplantation criteria for hepatocellular carcinoma should be expanded: a 22-year experience with 467 patients at UCLA

OBJECTIVE: To assess the efficacy of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) and the impact of current staging criteria on long term survival. SUMMARY BACKGROUND DATA: HCC is becoming an increasingly common indication for OLT. Medicare approves OLT only for HCCs meeting the Milan criteria, thus limiting OLT for an expanding pool of potential liver recipients. We analyzed our experience with OLT for HCC to determine if expansion of criteria for OLT for HCC is warranted. METHODS:: All patients undergoing OLT for HCC from 1984 to 2006 were evaluated. Outcomes were compared for patients who met Milan criteria (single tumor < opr =5 cm, maximum of 3 total tumors with none >3 cm), University of California, San Francisco (UCSF) criteria (single tumor <6.5 cm, maximum of 3 total tumors with none >4.5 cm, and cumulative tumor size <8 cm), or exceeded UCSF criteria. RESULTS: A total of 467 transplants were performed for HCC. At mean follow up of 6.6 +/- 0.9 years, recurrence rate was 21.2%, and overall 1, 3, and 5-year survival was 82%, 65%, and 52%, respectively. Patients meeting Milan criteria had similar 5-year post-transplant survival to patients meeting UCSF criteria by preoperative imaging (79% vs. 64%; P = 0.061) and explant pathology (86% vs. 71%; P = 0.057). Survival for patients with tumors beyond UCSF criteria was significantly lower and was below 50% at 5 years. Multivariate analysis showed that tumor number (P < 0.001), lymphovascular invasion (P < 0.001), and poor differentiation (P = 0.002) independently predicted poor survival. CONCLUSIONS: This largest single institution experience with OLT for HCC demonstrates prolonged survival after liver transplantation for tumors beyond Milan criteria but within UCSF criteria, both when classified by preoperative imaging and by explant pathology. Measured expansion of OLT criteria is justified for tumors not exceeding the UCSF criteria.     

肝癌肝移植的标准及其与预后的关系

目的 评价肝移植治疗肝细胞癌的价值以及受者选择对病人术后存活的影响.方法 对我院2000年6月至2007年2月实施的63例原发性肝细胞癌肝移植临床资料进行回顾性分析.采用kaplan-meier法进行生存率统计分析.结果 63例原发性肝细胞癌病人肝移植术后1、3、5年累积生存率分别为77.4%、59.3%、48.9%.符合Milan标准、符合UCSF标准和不符合UCSF标准受者,肝移植术后1、3、5年累积生存率分别为93.8%、92.1%、29.2%;80.8%、79.2%、8.3%;80.8%、79.2%、0.符合Milan标准、符合UCSF标准和不符合UCSF标准受者,术后1、2、3年肿瘤累积复发率分别为6.2%、15.5%、19.2%;7.9%、15.9%、20.8%;70.8%、87.5%、91.7%(P＜0.01).但是,符合UCSF标准与符合Milan标准受者移植术后累积生存率和肝癌累积复发率相似(P＞0.05).结论 以UCSF标准筛选肝癌病人进行肝移植不仅扩大了肝癌肝移植的适应证,还可以取得与Milan标准同样的效果.     

mTOR抑制剂对肝细胞癌肝移植患者术后生存的影响

目的研究肝细胞癌患者肝移植术后使用mTOR抑制剂为主的免疫抑制剂方案对肿瘤复发及生存期的影响。方法收集我中心2005年1月至2008年12月期间因肝细胞癌行肝移植手术的病例建立数据库。根据患者术后所使用的免疫抑制方案分为两组,单CNIs免疫抑制剂组和含西罗莫司(Rapa)组。按照术前肿瘤所符合的移植标准(米兰标准、UCSF标准以及超标准)对组内病例分层分析,对比各组病例之间在肿瘤复率发、无瘤生存期及总生存期方面的差别。结果对于米兰标准及UCSF标准患者,两组间在肿瘤复发率、无瘤生存期和总生存期方面差别无统计学意义;超标准患者两组无瘤生存率无显著差异,含Rapa组总生存期优于单CNIs组(P0.05)。结论超标准肝癌患者术后使用mTOR抑制剂对于延长患者生存期具有一定作用。     

Predictors of Outcome of Living Donor Liver Transplantation for Hepatocellular Carcinoma

The aim of this work is to study the different factors that affect the outcome of living donor liver transplantation for patients with hepatocellular carcinoma (HCC). Between April 2003 to November 2014, 62 patients with liver cirrhosis and HCC underwent living donor liver transplantation (LDLT) in the National Liver Institute, Menoufia University, Egypt. The preoperative, operative, and postoperative data were analyzed. After studying the pathology of explanted liver; 44 (71 %) patients were within the Milan criteria, and 18 (29 %) patients were beyond Milan; 13 (21.7 %) of patients beyond the Milan criteria were also beyond the University of California San Francisco criteria (UCSF) criteria. Preoperative ablative therapy for HCC was done in 22 patients (35.5 %), four patients had complete ablation with no residual tumor tissues. Microvascular invasion was present in ten patients (16 %) in histopathological study. Seven (11.3 %) patients had recurrent HCC post transplantation. The 1, 3, 5 years total survival was 88.7, 77.9, 67.2 %, respectively, while the tumor-free survival was 87.3, 82.5, 77.6 %, respectively. Expansion of selection criteria beyond Milan and UCSF had no increased risk effect on recurrence of HCC but had less survival rate than patients within the Milan criteria. Microvascular invasion was an independent risk factor for tumor recurrence.     

Number and Tumor Size Are Not Sufficient Criteria to Select Patients for Liver Transplantation for Hepatocellular Carcinoma

Background

Hepatocellular carcinoma (HCC) is an indication for liver resection or transplantation (LT). In most centers, patients whose HCC meets the Milan criteria are considered for LT. The first objective of this study was to analyze whether there is a correlation between the pathologic characteristics of the tumor, survival and recurrence rate. Second, we focused our attention on vascular invasion (VI).

Methods

From January 1997 to December 2007, a total of 196 patients who had a preoperative diagnosis of HCC were included. The selection criteria for LT satisfied both the Milan and the San Francisco criteria (UCSF). Demographic, clinical, and pathologic information were recorded.

Results

HCC was confirmed in 168 patients (85.7%). The median follow-up was 74?months. The pathologic findings showed that 106 patients (54.1%) satisfied the Milan criteria, 134 (68.4%) the UCSF criteria of whom 28 (14.3%) were beyond the Milan criteria but within the UCSF criteria, and 34 (17.3%) beyond the UCSF criteria. VI was detected in 41 patients (24%). The 1-, 3-, and 5-year overall survival rates were 90%, 85%, and 77%, respectively, according to the Milan criteria and 90%, 83%, and 76%, respectively, according to the UCSF criteria (P?=?NS). In univariate and multivariate analyses, tumor size and VI were significant prognostic factors affecting survival (P?400?ng/ml and tumor grade G3.

Conclusions

Tumor size and VI were the only significant prognostic factors affecting survival of HCC patients. Primary liver resection could be a potential selection treatment before LT.