局部治疗在中国肝细胞癌肝移植中的应用分析
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摘要
目的探讨移植术前局部治疗在肝癌肝移植治疗中的临床应用价值。方法回顾性分析中国肝移植注册中心(China Liver Transplant Registry,CLTR)成立至2016年10月的1739例肝癌肝移植患者的临床及随访数据,分析其术前局部治疗史及患者肿瘤分期对患者预后的影响。结果共纳入米兰标准组563例,局部治疗组234例,米兰标准组患者1、3、5年整体生存率分别为88.66%、76.29%和67.02%,局部治疗组患者1、3、5年整体生存率分别为78.33%、40.77%和29.12%。局部治疗组中,术后病理AJCCⅠ-Ⅱ期肿瘤患者1年和3年生存率分别为85.14%和60.95%,与符合米兰标准的患者整体生存差异无统计学意义(P=0.12)。移植术前局部治疗中,肝肿瘤射频消融术及经导管肝动脉栓塞化疗术分别占36.5%和47.0%,混合疗法占15.82%,采用3种治疗方案的患者,术后总体生存时间无显著差异(P=0.352)。结论移植术前局部治疗已广泛应用于肝癌肝移植患者。局部治疗后超米兰标准但小于AJCCⅡ期的患者,仍可作为肝移植的良好受体。肝肿瘤射频消融术、经导管肝动脉栓塞化疗术以及联合疗法均可作为肝癌移植术前的局部治疗方案。
Objective To discuss the clinical application value of locoregional therapy in liver transplantation for hepatocellular carcinoma in China. Methods We retrospectively reviewed the data of 1739 transplantation recipients registered in the China Liver Transplant Registry(CLTR)till October 2016 who suffered from hepatocellular carcinoma. The utilization of locoregional therapy was summarized, and its influence on the survival of transplantation recipients was analyzed. Results A total of 563 cases met the Milan criteria, 234 cases received pre-transplantation locoregional therapy. The 1-year, 3-year and 5-year overall survival rate of the patients in the Milan criteria group were 88.66%, 76.29% and 67.02%, respectively. While the 1-year, 3-year and 5-year overall survival rate of the patients in the locoregional therapy group were 78.33%, 40.77% and 29.12%, respectively. The 1-year, 3-year overall survival of patients with AJCC Stage Ⅰ-Ⅱ tumors were 85.14% and 60.95%,which was similar to the survival of the patients in the Milan criteria group(P = 0.12). Radiofrequency ablation, transcatheter arterial chemoembolization, and multimodality therapy were used in 36.5%, 47.0%, 15.82%patients of the locoregional therapy group. The survival of patients who received these three treatment showed no difference(P = 0.352). Conclusion Pre-transplantation locoregional therapy have been widely used. Patients who exceed the Milan criteria but within the AJCC stage Ⅱ were still good candidates for liver transplantation. The effect of radiofrequency ablation, transcatheter arterial chemoembolization, and multimodality therapy were equivalent in the pre-transplantation therapy.
Objective To discuss the clinical application value of locoregional therapy in liver transplantation for hepatocellular carcinoma in China. Methods We retrospectively reviewed the data of 1739 transplantation recipients registered in the China Liver Transplant Registry(CLTR)till October 2016 who suffered from hepatocellular carcinoma. The utilization of locoregional therapy was summarized, and its influence on the survival of transplantation recipients was analyzed. Results A total of 563 cases met the Milan criteria, 234 cases received pre-transplantation locoregional therapy. The 1-year, 3-year and 5-year overall survival rate of the patients in the Milan criteria group were 88.66%, 76.29% and 67.02%, respectively. While the 1-year, 3-year and 5-year overall survival rate of the patients in the locoregional therapy group were 78.33%, 40.77% and 29.12%, respectively. The 1-year, 3-year overall survival of patients with AJCC Stage Ⅰ-Ⅱ tumors were 85.14% and 60.95%,which was similar to the survival of the patients in the Milan criteria group(P = 0.12). Radiofrequency ablation, transcatheter arterial chemoembolization, and multimodality therapy were used in 36.5%, 47.0%, 15.82%patients of the locoregional therapy group. The survival of patients who received these three treatment showed no difference(P = 0.352). Conclusion Pre-transplantation locoregional therapy have been widely used. Patients who exceed the Milan criteria but within the AJCC stage Ⅱ were still good candidates for liver transplantation. The effect of radiofrequency ablation, transcatheter arterial chemoembolization, and multimodality therapy were equivalent in the pre-transplantation therapy.
引文
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[2]张玉,杨炜.原发性肝癌行肝移植前的桥接治疗[J].微创医学,2014,9(6):763-765.
[3]Lee MW,Raman SS,Asvadi NH,et al.Radiofrequency ablation of hepatocellular carcinoma as bridge therapy to liver transplantation:a 10-year intention-to-treat analysis[J].Hepatology,2017,65(6):1979-1990.
[4]Kollmann D,Selzner N,Selzner M.Bridging to liver transplantation in HCC patients[J].Langenbecks Arch Surg,2017,402(6):863-871.
[5]Yao FY,Mehta N,Flemming J,et al.Downstaging of hepatocellular cancer before liver transplant:long-term outcome compared to tumors within Milan criteria[J].Hepatology,2015,61(6):1968-1977.
[6]Xing M,Kim HS.Independent prognostic factors for posttransplant survival in hepatocellular carcinoma patients undergoing liver transplantation[J].Cancer Med,2017,6(1):26-35.
[7]Mazzaferro V,Regalia E,Doci R,et al.Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis[J].N Engl J Med,1996,334(11):693-699.
[8]She WH,Cheung TT.Bridging and downstaging therapy in patients suffering from hepatocellular carcinoma waiting on the list of liver transplantation[J].Transl Gastroenterol Hepatol,2016,14(1):34.