肝移植治疗原发性肝癌

目的评价原位肝移植治疗原发性肝癌的疗效和受体选择,探讨原位肝移植在原发性肝癌治疗中的作用和地位.方法回顾性分析1999年1月至2005年2月完成的9 2例原发性肝癌肝移植患者的临床资料.结果原发性肝癌肝移植92例,根据国际抗癌协会的国际癌症病期分类（TNM）,Ⅰ期8例,ChildPugh均为A级;Ⅱ期13例,Child-Pugh A级11例、B级2例;Ⅲ期12例,Child-Pugh A级8例、B级3例、C级1例;Ⅳ期59例,Child-Pugh A级52例、B级5例、C级2例.手术成功75例,成功率81.5%,围手术期死亡17例,病死率18.5%.随访6～68个月,最短生存40 d,最长无瘤生存68个月,肿瘤最短51 d复发,生存时间3年以上的7例患者至今仍无瘤生存.Ⅰ期：1年生存者5例,2年生存者3例,3年生存者2例,5年生存者1例;Ⅱ期：1年生存者6例,2年生存者2例,3年生存者2例;Ⅲ期：1年生存者3例,无生存超过2年者;Ⅳ期：1年生存者18例,2年生存者5例,3年生存者3例,5年生存者1例.Ⅰ、Ⅱ期的生存率显著高于Ⅲ、Ⅳ期.术后出现原发性肝癌复发35例,总复发率为46.7%.Ⅰ、Ⅱ、Ⅲ、Ⅳ期的复发率分别为12.5%、0、50.0%和47.5%,Ⅲ、Ⅳ期的复发率明显高于Ⅰ、Ⅱ期.结论不同期原发性肝癌肝移植术后的生存情况差别较大,肝移植治疗早期原发性肝癌效果显著,进展期原发性肝癌由于移植效果差应持慎重态度.

Liver transplantation for treating hepatocellular carcinoma

OBJECTIVE: To evaluate the role of orthotopic liver transplantation (OLT) in treating hepatocellular carcinoma (HCC). METHODS: Data of 92 consecutive orthotopic liver transplantations (OLTs) performed during January 1999 and February 2005 at our institution were analyzed. RESULTS: Of the 92 recipients, 8 HCC patients were stage I, 13 were stage II, 12 stage III and 59 stage IV (UICC TNM staging system). Overall 1-, 2-, 3-, 5-year patient survival rates were 65.3%, 27.0%, 20.0%, and 6.9%, respectively. When OLT indications were considered, best recipients survival was obtained in stage I patients (100.0%, 100.0%, 66.7%, and 50.0% at 1, 2, 3, and 5 years, respectively) and stage II patients (85.7%, 66.7%, and 66.7% at 1, 2 and 3 years, respectively). Whereas, 1, 2, 3 and 5-year recipients survival rates were 50.0%, 0, 0, 0 in stage III patients, and 58.1%, 20.0%, 13.0% and 5.0% in stage IV patients. CONCLUSIONS: The prognosis of different stages of HCC patients who underwent OLT was significantly different. The OLT recipients with HCC should be strictly selected. Long-term recipient survival could be obtained in stage I and stage II patients.