直径达8厘米的孤立性肝细胞癌患者接受活体供肝原位肝移植后的长期良好生存情况。
Good longterm survival after primary living donor liver transplantation for solitary hepatocellular carcinomas up to 8 cm in diameter.
作者信息
Dai Wing Chiu, Chan See Ching, Chok Kenneth S H, Cheung Tan To, Sharr William W, Chan Albert C Y, Tsang Simon H Y, Fung James Y Y, Poon Ronnie T P, Fan Sheung Tat, Lo Chung Mau
机构信息
Department of Surgery, University of Hong Kong, Hong Kong, China.
出版信息
HPB (Oxford). 2014 Aug;16(8):749-57. doi: 10.1111/hpb.12212. Epub 2014 Jan 28.
OBJECTIVES
There is controversy over whether hepatocellular carcinoma (HCC) should be primarily treated with living donor liver transplantation (LDLT) if liver resection (LR) can be effective. This retrospective study was conducted to compare survival outcomes in patients treated with either modality for solitary HCC measuring ≤8 cm in diameter.
METHODS
Outcomes in patients with solitary HCC primarily treated by LDLT were analysed. Patients with solitary HCC of similar sizes with or without microvascular invasion primarily treated with LR were selected at a ratio of 6 : 1 for comparison.
RESULTS
In-hospital mortality amounted to 0% and 1.3% in the LDLT (n = 50) and LR (n = 300) groups, respectively (P = 0.918). Complication rates were 34% and 20% in the LDLT and LR groups, respectively (P = 0.027). Rates of 1-, 3-, 5- and 10-year overall survival were 98%, 94%, 89% and 83%, respectively, in the LDLT group and 95%, 85%, 76% and 56%, respectively, in the LR group (P = 0.013). Rates of 1-, 3-, 5- and 10-year disease-free survival were 96%, 90%, 87% and 81%, respectively, in the LDLT group and 81%, 64%, 57% and 40%, respectively, in the LR group (P < 0.0001).
CONCLUSIONS
Living donor liver transplantation surpassed LR in survival outcomes, achieving a 10-year overall survival rate 1.5 times as high and a 10-year disease-free survival rate twice as high as those facilitated by LR. However, it entailed more complications, in addition to the inevitable risks to the donor.
目的
对于直径≤8厘米的孤立性肝细胞癌（HCC），若肝切除术（LR）有效，是否应首选活体肝移植（LDLT）治疗存在争议。本回顾性研究旨在比较采用这两种方式治疗的此类孤立性HCC患者的生存结局。
方法
分析主要接受LDLT治疗的孤立性HCC患者的结局。选择主要接受LR治疗、大小相似且有或无微血管侵犯的孤立性HCC患者，按6∶1的比例进行比较。
结果
LDLT组（n = 50）和LR组（n = 300）的院内死亡率分别为0%和1.3%（P = 0.918）。LDLT组和LR组的并发症发生率分别为34%和20%（P = 0.027）。LDLT组的1年、3年、5年和10年总生存率分别为98%、94%、89%和83%，LR组分别为95%、85%、76%和56%（P = 0.013）。LDLT组的1年、3年、5年和10年无病生存率分别为96%、90%、87%和81%，LR组分别为81%、64%、57%和40%（P < 0.0001）。
结论
活体肝移植在生存结局方面优于肝切除术，10年总生存率是肝切除术的1.5倍，10年无病生存率是肝切除术的两倍。然而，除了给供体带来不可避免的风险外，它还会引发更多并发症。
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