文章：

原发性与挽救性肝移植在肝细胞癌根治性切除或射频消融后的长期肿瘤学结果比较

Primary versus Salvage Liver Transplantation after Curative-Intent Resection or Radiofrequency Ablation for Hepatocellular Carcinoma: Long-Term Oncological Outcomes

原文发布日期：18 October 2023

DOI: 10.3390/cancers15205030

类型: Article

开放获取: 是

英文摘要：

Liver transplantation for hepatocellular carcinoma (HCC) may be performed ab initio, primary liver transplantation (PLT), or for HCC recurrence after previous treatments such as liver resection (LR) or radiofrequency ablation (RFA), salvage liver transplantation (SLT). The aim of this study was to evaluate the oncological outcomes of SLT vs. PLT. For this, a retrospective study was carried out on patients undergoing liver transplantation for HCC. The outcomes of PLT were compared with those of SLT. The primary outcome was disease-free survival (DFS). The secondary outcomes included overall survival (OS), cancer-specific survival (CSS), and major postoperative complications. A sub-analysis of SLT-LR and SLT-RFA was also performed. In total, 141 patients were included: 96 underwent PLT and 45 SLT. Among the SLT group, 25 patients had undergone previous LR while 20 had had RFA. There were no differences in the major postoperative complications. Unadjusted DFS was significantly longer in the PLT group (p= 0.02), as were OS (p= 0.025) and CSS (p= 0.001). There was no difference in DFS between PLT and SLT-LR groups, while a significant difference was found between the PLT and SLT-RFA groups (p= 0.035). Nonetheless, DFS was no different between the SLT-LR and SLT-RFA groups. PLT appears to offer superior long-term oncological outcomes to SLT. Both SLT-LR and SLT-RFA offer acceptable OS and CSS. Further prospective studies are needed to confirm these results, but the re-direction of grafts and transplant philosophy towards PLT rather than SLT may need to be considered.

摘要翻译： 

针对肝细胞癌（HCC）的肝移植，可分为初次肝移植（PLT）以及因既往接受肝切除术（LR）或射频消融术（RFA）等治疗后出现HCC复发而施行的挽救性肝移植（SLT）。本研究旨在评估SLT与PLT的肿瘤学预后。为此，我们对因HCC接受肝移植的患者进行了回顾性研究，比较了PLT与SLT的预后。主要结局指标为无病生存期（DFS），次要结局指标包括总生存期（OS）、癌症特异性生存期（CSS）及主要术后并发症。同时，对SLT-LR与SLT-RFA进行了亚组分析。研究共纳入141例患者：96例接受PLT，45例接受SLT。在SLT组中，25例患者既往接受过LR，20例接受过RFA。两组在主要术后并发症方面无显著差异。未经校正的DFS在PLT组显著更长（p=0.02），OS（p=0.025）和CSS（p=0.001）亦如此。PLT组与SLT-LR组的DFS无差异，而PLT组与SLT-RFA组之间存在显著差异（p=0.035）。尽管如此，SLT-LR组与SLT-RFA组之间的DFS并无不同。PLT似乎较SLT具有更优的长期肿瘤学预后。SLT-LR与SLT-RFA均可提供可接受的OS和CSS。需要进一步的前瞻性研究来验证这些结果，但或许需要考虑将移植策略和理念转向PLT而非SLT。

原文链接：

Primary versus Salvage Liver Transplantation after Curative-Intent Resection or Radiofrequency Ablation for Hepatocellular Carcinoma: Long-Term Oncological Outcomes