Lo CM, Fan ST, Liu CL, Chan SC, Ng IO, Wong J.
外科，香港大学，玛丽医院，薄扶林道102号，香港，中国. chungmlo@hkucc.hku.hk

背景：研究人员开展了一项运用活体供肝肝移植（LDLT）治疗早期肝细胞癌（HCC）的假设性研究，假设活体供肝肝移植（LDLT）的疗效和尸体供肝肝移植（DDLT）的疗效具有可比性。
本研究的目的是比较LDLT的疗效和DDLT的疗效，并确定可能造成这种差异的因素。

方法：这项研究包括60例符合放射学米兰标准或加州大学旧金山标准（UCSF）的患者，其中43例进行了亲体肝移植，17例进行了尸体肝移植。

结果：亲体肝移植组较少出现偶发肝癌，肝动脉化疗栓塞的发生率也很低，但是补救式肝移植的发生率较高。同时，该组患者的等待时间相对较短，而且移植肝体积和标准肝体积（GW : SLW）的比率也较低。手术过程与组织病理学肿瘤大小、数目、分期等则相差无几。平均随访时间为33个月（范围是4至120个月）。活体肝移组和尸体肝移植组的累计5年复发率分别为29%和0%（P = 0.029）。GW : SLW比率为0.6或更低、补救式肝移植、三个或更多肿瘤结节、微血管浸润、超出米兰标准或UCSF标准的病理学分期都是显著的风险因素。多变量分析法将补救式肝移植（相对风险为5.16 (c.i. 95% 1.48至18.02)；P=0.010）和超出UCSF标准的病理学分期（相对风险为4.10（c.i. 95% 1.02至16.48）；P=0.047）确定为独立的复发预测因素。

结论：尽管标准放射性选择标准建立在数目和大小的基础之上，但是以活体肝移植治疗肝细胞癌的患者因选择偏差，复发率更高。

Living donor versus deceased donor liver transplantation for early irresectable hepatocellular carcinoma.
Lo CM, Fan ST, Liu CL, Chan SC, Ng IO, Wong J.
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China. chungmlo@hkucc.hku.hk

BACKGROUND: Hypothetical studies that favour living donor liver transplantation (LDLT) for early hepatocellular carcinoma (HCC) assumed a comparable outcome after LDLT and deceased donor liver transplantation (DDLT). The aim of this study was to compare the outcome after LDLT with that after DDLT, and to identify factors that might account for any differences.

METHODS: The study included 60 patients who met the radiological Milan or University of California at San Francisco (UCSF) criteria and underwent LDLT (43 patients) or DDLT (17).

RESULTS: The LDLT group had fewer incidental tumours and a lower rate of pretransplant transarterial chemoembolization but a higher rate of salvage transplantation. Waiting time was shorter and graft weight to standard liver weight (GW : SLW) ratio was lower in this group. The perioperative course, and histopathological tumour size, number, grade and stage were comparable. Median follow-up was 33 (range 4-120) months. The cumulative 5-year recurrence rate was 29 per cent in the LDLT group and 0 per cent in the DDLT group (P = 0.029). A GW : SLW ratio of 0.6 or less, salvage transplantation, three or more tumour nodules, microscopic vascular invasion, and pathological stage beyond the Milan or UCSF criteria were significant confounding risk factors. Multivariable analysis identified salvage transplantation (relative risk 5.16 (95 per cent confidence interval (c.i.) 1.48 to 18.02); P = 0.010) and pathological stage beyond the UCSF criteria (relative risk 4.10 (95 per cent c.i. 1.02 to 16.48); P = 0.047) as independent predictors of recurrence.

CONCLUSION: Despite standard radiological selection criteria based on number and size, patients who underwent LDLT for HCC had more recurrence because of selection bias for other clinical characteristics.

Copyright 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
PMID: 17016793 [PubMed - indexed for MEDLINE

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