Resection or transplantation for hepatocellular carcinoma in cirrhotic patients: Outcomes based on indicated treatment strategy

作     者：Figueras, J Jaurrieta, E Valls, C Ramos, E Serrano, T Rafecas, A Fabregat, J Torras, J 

作者机构：Univ Barcelona Ciutat Sanitaria Univ Bellvitge Liver Transplant Unit Barcelona Spain 

出 版 物：《JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS》 (美国外科医生学会志)

年 卷 期：2000年第190卷第5期

页      面：580-587页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Carcinoma Hepatocellular Hepatectomy Liver Cirrhosis Liver Neoplasms 癌 肝细胞 肝切除术 肝硬化 肝肿瘤 肝移植 Liver Cirrhosis Organ Donors Survival Rate Carcinoma Hepatocellular Cancer Hepatectomy Liver Neoplasms Relapse Human-centered computing Optical Line Terminal Transplantation ectomy 

摘      要：Background: Surgical resection has been the treatment of choice for hepatocellular carcinoma (HCC), but the resection rate remains low in cirrhotic patients and recurrence is common. Unfavorable results compared with benign disease and the shortage of organ donors have led to a restricted indication for orthotopic liver transplantation (OLT) for HCC. Study Design: The aim of this study was to analyze the results of our surgical approach to HCC in patients with cirrhosis. The first treatment strategy indicated in these patients was OLT. From January 1990 to May 1999, 85 patients underwent OLT and the remaining 35 had surgical resection. Results: One-, 3-, and 5-year survival rates were 84%, 74%, and 60% versus 83%, 57%, and 51%, respectively, in the OLT and resection groups (p = 0.34). Hepatic tumor recurrence was much less frequent in the OLT group than in the resection group. The 1-, 3-, and 5-year disease-free survival rates were 83%, 72%, and 60% versus 70%, 44%, and 31%, respectively (p = 0.027). In the multivariate Cox regression analysis, macroscopic vascular invasion was the only factor independently associated with death or recurrence after OLT (p = 0.006). After partial liver resection, the tumors significantly associated with mortality and recurrence in the multivariate analysis were solitary or multiple tumors greater than 2 cm with microscopic vascular invasion (pathologic pT3) (p = 0.01). Conclusions: Our results confirm that in cirrhotic patients, OLT may provide better outcomes than liver resection in carefully selected HCC and that longterm survival is similar to the results of OLT in cirrhotic patients without tumors. (J Am Coil Surg 2000;190: 580-587. (C) 2000 by the American College of Surgeons).