英国肝癌治疗指南肝移植片段的节选

linx

希望给考虑移植的战友一个参考。

这个是2009年的，今年会修订新版，但还没出来。全文的链接在这里，  http://www.mccn.nhs.uk/userfiles/documents/04a%20HCC%20guidelines%20accepted%20version%20march%2009.pdf

其实大多数的基本路数都一样，但是里面发现肝移植部分和以前有点不同。转贴如下并简要翻译。

(ii) Selecting patients for liver transplantation  

Early results for liver transplantation for HCC were poor (112, 113) with 5 year survival figures well below 50% mainly due to tumour recurrence.  It is now clear that this was the result of poor selection of patients for transplantation.  It is well established that patients with single lesions of 5cm diameter or up to five lesions of less than 3cm in the absence of vascular invasion as defined by imaging, have
an almost zero recurrence rate for the HCC and the  prognosis after transplantation is the same as for a similar underlying liver disease without HCC (115, 116, 117).   The criteria for selection to the transplant list for cases with HCC has recently been revised and current UK guidelines from May 2008 (118) advise the following:  

早年认为肝癌后肝移植生存率很低《50%。现在已经清楚了那是因为患者选择的问题。符合米兰标准的基本是0复发，预后和其他肝病移植类似。下面是新标准

1. Radiological assessment should include both multidetecor (MD) CT and MRI with size being assessed by the widest dimensions on either scan.    要用CT和MRI一起确定肿瘤的最大尺寸。
2. A lesion (for the purposes of counting numbers) will require to be identified as an arterialised focal abnormality with portal phase washout on MDCT or Gd enhanced MR.  Other lesions are considered indeterminate.
这个不会翻，懂术语的来吧。似乎说这个肿瘤必须是动脉异常并且在增强核磁或CT上要静脉期是浅色的？不符合这个标准的不计在内

3. Tumour rupture and an aFP > 10,000 iu/l are absolute contraindications to transplantation, as are extrahepatic spread and macroscopic vascular invasion.
肿瘤破裂和AFP大于10000的和肝外转移和大血管侵犯都是禁忌。

4. The following are criteria for listing for transplantation;
•  a single lesion < 5 cms diameter or  
•  up to 5 lesions all < 3 cms
•  single lesion > 5 cms  < 7 cms diameter where there has been no evidence of tumour progression (volume increase by <20%; no extrahepatic spread; no new nodule formation) over a 6 month period.  Locoregional +/- chemotherapy may be given during that time.  Their waiting list place may be considered from the time of their first staging scan.

这个是新的标准： 米兰标准的宽。单个5cm，多发5个一下，最大《3cm。5-7cm的肿瘤如果6个月内没有进展 （体积增加《20% ，没有肝外转移，没有新发）。这期间可以给予治疗。


5. Locoregional therapy should be considered for all transplant list cases.
等肝期间都应该给予局部治疗。

6. Cases outwith current proposed selection criteria will not be selectable on to the transplant list after their tumour has been downsized by surgical or loco-regional treatments.

手术后或局部治疗后大小达到上述标准的也不能列入排队。

naissine

A lesion (for the purposes of counting numbers) will require to be identified as an arterialised focal abnormality with portal phase washout on MDCT or Gd enhanced MR.  Other lesions are considered indeterminate.

为明确病灶数目，一个（癌性）病变的确定必须在多排螺旋CT或者Gd增强MR中具有动脉相增强门脉相减退（即快进快出）的影像表现。其他类型的病变被认为是性质不确定的。

yorklee

6. Cases outwith current proposed selection criteria will not be selectable on to the transplant list after their tumour has been downsized by surgical or loco-regional treatments.

手术后或局部治疗后大小达到上述标准的也不能列入排队。

切除前未超米兰尺寸的肿瘤在切除后也不能移植？

naissine

回复 yorklee 的帖子

yorklee你直接读原文就没有这个疑问了。linx翻得比较意会且有所省略：
6. Cases outwith current proposed selection criteria will not be selectable on to the transplant list after their tumour has been downsized by surgical or loco-regional treatments.

（术前超标准的，即使）手术后或局部治疗后大小达到上述标准也不能列入排队。

乐肝乐

认真学习了！大家辛苦了！

yorklee

回复 naissine 的帖子

不好意思，只顾看中文了。英文原文的意思就能理解了，确实该如此。谢谢！

linx

就是说大肿瘤切小的不算。但那个5-7厘米间的如果能够被控制，而且半年内没有肝外转移和新发的就可以排队。这个考虑了肿瘤本身的生物学特性，也给不少人多了一分希望。

宁静

好文。。。

英文文字很严谨。。

宁静

回复 linx 的帖子

这个确实让一部分病友看到了希望。。