肝硬化肝硬化患者的肝移植治疗肝移植：意向性治疗分析

StephenW

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

    Accepted manuscript online: 14 August 2017Full publication history
    DOI: 10.1002/hep.29468  View/save citation
    Cited by (CrossRef): 0 articles Check for updates

ABSTRACT

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.

StephenW

肝硬化肝硬化患者的肝移植治疗肝移植：意向性治疗分析
作者

    在线接受手稿：2017年8月14日全文出版历史
    DOI：10.1002 / hep.29468查看/保存引用
    引用（CrossRef）：0篇文章检查更新

抽象

对于最初可切除和可移植（R＆T）肝细胞癌（HCC）患者，构想了抢救性肝移植（SLT）策略，试图消除前期LT，在切除后复发的情况下，采用SLT的“安全网”。当患者仅在原发性切除术后或SLT复发后患者无复发时，SLT策略成功或治愈。本研究的目的是确定SLT策略在R＆T HCC患者中治愈的潜力，并确定其成功的预测因素。

从1994年至2012年，所有R＆T肝硬化HCC患者都参加了SLT策略。根据上述定义，使用意向治疗（ITT）分析来确定该策略的成果和成功的预测因素。

共有110名患者入选SLT策略。 63例患者（57％）在初次切除后有肿瘤复发，30例SLT可以进行（复发率= 48％）。从最初切除时起，ITT 5年整体无病生存率分别为69％和60％。 SLT策略在60例（56％）中获得成功，无论是单独切除（36％）还是通过SLT复发（19％）。多变量分析成功SLT策略的切除前预测因素包括终末期肝病模型（MELD）评分> 10，新辅助动脉栓塞化疗栓塞（TACE）。另外的切除后预测因素是切除后发病率不存在，切除标本的T-stage 1-2。

结论：SLT策略仅在56％的病例中治愈。策略开始时MELD评分较高，无切除前TACE是SLT策略成功的预测指标。本文受版权保护。版权所有。