Abstract
Aim. To evaluate the long-term results of liver transplantation for hepatocellular carcinoma. To perform an analysis of risk factors for tumor recurrence.Materials and methods. A retrospective analysis of 63 deceased donor liver transplantations, which were performed from January 2010 to February 2020. Patients were divided into three groups according to the Milan and California criteria – within the Milan criteria, outside the Milan criteria, but within the California criteria, outside the California criteria.Results. There were 33 recipients within the Milan criteria, 5 within the California criteria, and 25 outside the California criteria. The 5-years recurrence rate was 9.1%, 40% and 52%, respectively (p = 0.002), five-year survival rate of – 93.2%, 66.7% and 54.7% (p = 0.041). Factors associated with an increased risk of recurrence: five and more tumor nodes (OR = 3.675; 95% CI (1.35–9.97); p = 0.011), macroscopic vascular invasion (OR = 5.97; 95% CI (2.06–17.31); p = 0.001) and inconsistency with California criteria (OR = 4.00; 95% CI (1.49–10.74); p = 0.006). The factors associated with a lower recurrence rate: one or two tumor nodes (p = 0.014 and 0.042, respectively), a high grade of histological differentiation (RR = 0.24; 95% CI (0.06–0.93); p = 0.039), compliance with Milanese criteria (RR = 0.18; 95% CI (0.06–0.58); p = 0.004).Conclusion. Liver transplantation can be performed in a number of patients beyond the Milan and California criteria. The morphological and biological characteristics of the tumor and a multidisciplinary differentiated approach to treatment have an important role in the success of treatment.
Highlights
Factors associated with an increased risk of recurrence: five and more tumor nodes (OR = 3.675; 95% CI (1.35–9.97); p = 0.011), macroscopic vascular invasion (OR = 5.97; 95% CI (2.06–17.31); p = 0.001) and inconsistency with California criteria (OR = 4.00; 95% CI (1.49–10.74); p = 0.006)
Analysis of the factors associated with recurrence of hepatocellular carcinoma after liver transplantation
Nissen N.N., Menon V., Bresee C., Tran T.T., Annamalai A., Poordad F., Fair J.H., Klein A.S., Boland B., Colquhoun S.D. Recurrent hepatocellular carcinoma after liver transplant: identifying the high-risk patient
Summary
В исследование включены 63 пациента, которым была выполнена ТП в НМИЦ ТИО им. академика В.И. Критериями включения в исследование считали возраст >15 лет, предтрансплантационный диагноз ГЦР, отсутствие внепеченочного распространения опухоли на момент трансплантации, гистологическое подтверждение ГЦР в эксплантированном органе. Пол, индекс массы тела (ИМТ), прохождение down-stage терапии, максимальный уровень АФП до трансплантации. Для сравнения параметрических показателей между группами применяли дисперсионный анализ (ANOVA). При сравнении непараметрических показателей между группами применяли критерий Краскела–Уоллиса. Мультивариантную регрессионную модель Кокса (пропорциональных рисков) применяли для определения характеристик, ассоциированных с рецидивом ГЦР в течение 5 лет после ТП. В группе соответствия МК было 33 (52,4%) реципиента, в группе реципиентов, характеристики которых не соответствовали МК, но отвечали критериям UCSF, – 5 (7,9%). В группе несоответствия МК и UCSF было 25 (39,7%) реципиентов.
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