Öz
Amaç: Karaciğer nakli (KN), hepatosellüler karsinom (HSK) için en iyi tedavi seçeneği olmaya devam etmektedir. Milano kriterlerinin ortaya çıktığı 1996 yılından bu yana, hasta seçimi çok önem kazanmıştır ancak bu kriterlerin kısıtlayıcılığı tartışılmaktadır. Canlı vericili KN dünya çapında artık daha rutin bir şekilde yapıldığından, daha fazla hastanın bu tedaviden faydalanabilmesi için orijinal kriterlere ek olarak birçok yeni kriter ve / veya bu kriterlerin genişletilmiş versiyonları literatürde önerilmektedir.
Bu çalışma, KN ile kabul edilebilir sonuçlar elde edilen hastaların sayısını artırmak için literatürdeki her gün daha da büyüyen dataya katkıda bulunmayı amaçlamaktadır.
Gereç ve Yöntem: Altı yıllık bir sürede HSK için KN uygulanan 187 yetişkin hastanın tıbbi kayıtları retrospektif olarak toplandı. Hastalar Milan ve UCSF kriterlerine göre sınıflandırıldı. Her hasta için sağ kalım süreleri, tümör, karaciğer hastalığı ve nüks ile ilgili veriler kaydedildi ve sonuçlar istatistiksel olarak analiz edildi.
Bulgular: Nüks ve sağ kalımı önemli ölçüde etkileyen faktörler histolojik farklılaşma, tümörün sayısı ve büyüklüğü ve vasküler invazyon varlığı olarak saptandı. Serum alfa-fetoprotein düzeylerinin sonuçları önemli ölçüde etkilemediği görüldü.
Her iki kriteri de aşan hastalar arasında, toplam tümör boyutu 160 mm'den az olan hastaların sonuçları anlamlı derecede daha iyi olarak saptandı (p = 0,007).
Sonuç: Sonuç olarak, vasküler invazyon, kötü diferansiasyon, 6’dan fazla odak ve 160 mm'yi aşan tümörü olan HSK hastaları daha yüksek nüks oranları ve daha kötü sonuçlar göstermektedir.
Anahtar Kelimeler
Kaynakça
- Venook AP, Papandreou C, Furuse J, de Guevara LL. The incidence and epidemiology of hepatocellular carcinoma: a global and regional perspective. Oncologist. 2010;15 Suppl 4:5–13.
- Lee HW, Suh K-S. Expansion of the criteria for living donor liver transplantation for hepatocellular carcinoma. Curr Opin Organ Transplant. 2016 Apr;21(2):231–7.
- Lin S, Hoffmann K, Schemmer P. Treatment of hepatocellular carcinoma: a systematic review. Liver Cancer. 2012 Nov;1(3–4):144–58.
- Gunay Y, Guler N, Yaprak O, Dayangac M, Akyildiz M, Altaca G, et al. Living Donor Liver Transplantation Outcomes for Hepatocellular Carcinoma Beyond Milan or UCSF Criteria. Indian J Surg. 2015 Dec;77(Suppl 3):950–6.
- Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009 Jan;10(1):35–43.
- Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996 Mar 14;334(11):693–9.
- Bismuth H, Chiche L, Adam R, Castaing D, Diamond T, Dennison A. Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg. 1993 Aug;218(2):145–51.
- Iwatsuki S, Starzl TE, Sheahan DG, Yokoyama I, Demetris AJ, Todo S, et al. Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg. 1991 Sep;214(3):221–8; discussion 228-229.
- Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, et al. Liver transplantation for hepatocellular carcinoma: Expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001;33(6):1394–403.
- Silva MF, Sherman M. Criteria for liver transplantation for HCC: what should the limits be? J Hepatol. 2011 Nov;55(5):1137–47.
- DuBay D, Sandroussi C, Sandhu L, Cleary S, Guba M, Cattral MS, et al. Liver transplantation for advanced hepatocellular carcinoma using poor tumor differentiation on biopsy as an exclusion criterion. Ann Surg. 2011 Jan;253(1):166–72.
- Yopp AC, Marrero JA, Singal AG. Expansion of Criteria for Liver Transplantation in Hepatocellular Carcinoma: Better Patient Selection or a Slippery Slope? Ann Surg Oncol. 2017 Jul 1;24(7):1758–60.
- Kaido T. Selection Criteria and Current Issues in Liver Transplantation for Hepatocellular Carcinoma. LIC. 2016;5(2):121–7.
- Xu D-W, Wan P, Xia Q. Liver transplantation for hepatocellular carcinoma beyond the Milan criteria: A review. World J Gastroenterol. 2016 Mar 28;22(12):3325–34.
- Bonadio I, Colle I, Geerts A, Smeets P, Berardi G, Praet M, et al. Liver transplantation for hepatocellular carcinoma comparing the Milan, UCSF, and Asan criteria: long-term follow-up of a Western single institutional experience. Clin Transplant. 2015 May;29(5):425–33.
- Sugawara Y, Tamura S, Makuuchi M. Living donor liver transplantation for hepatocellular carcinoma: Tokyo University series. Dig Dis. 2007;25(4):310–2.
- Sapisochin G, Goldaracena N, Laurence JM, Dib M, Barbas A, Ghanekar A, et al. The extended Toronto criteria for liver transplantation in patients with hepatocellular carcinoma: A prospective validation study. Hepatology. 2016;64(6):2077–88.
- Toso C, Asthana S, Bigam DL, Shapiro AMJ, Kneteman NM. Reassessing selection criteria prior to liver transplantation for hepatocellular carcinoma utilizing the Scientific Registry of Transplant Recipients database. Hepatology. 2009 Mar;49(3):832–8.
- Toso C, Meeberg G, Hernandez-Alejandro R, Dufour J-F, Marotta P, Majno P, et al. Total tumor volume and alpha-fetoprotein for selection of transplant candidates with hepatocellular carcinoma: A prospective validation. Hepatology. 2015 Jul;62(1):158–65.
- Hakeem AR, Young RS, Marangoni G, Lodge JPA, Prasad KR. Systematic review: the prognostic role of alpha-fetoprotein following liver transplantation for hepatocellular carcinoma. Aliment Pharmacol Ther. 2012 May;35(9):987–99.
Öz
Aim: Liver transplantation (LT) remains the best treatment option for hepatocellular carcinoma (HCC). Patient selection is crucial and debated ever since the emerging of the Milan criteria in 1996. As live donor LT being more routinely performed worldwide, numerous new and/or expansions of the original criteria have been suggested to allow more patients to benefit from this superior treatment modality. This study aims to contribute to ever-growing data in search for better coverage of patients with acceptable outcomes.
Materials and Methods: Medical recordings of 187 adult patients who underwent LT for HCC in a 6-year period were retrospectively collected. Patients were classified by Milan and UCSF criteria. Survival times as well as tumor, liver disease and recurrence related data were recorded for each patient and the outcomes were statistically analyzed.
Results: Factors significantly affecting recurrence and survival were histologic differentiation, number and the size of the tumor and the presence of vascular invasion. Serum alpha-fetoprotein levels did not significantly affect outcomes.
Among the patients exceeding both of the criteria, having a total tumor size of less than 160 mm was significantly associated with better outcomes (p=0,007).
Conclusion: In conclusion, HCC patients having tumors with vascular invasion, poor differentiation, exceeding 6 in number and 160 mm in total diameter demonstrate higher recurrence rates and worse outcomes.
Anahtar Kelimeler
Hepatocellular cancer liver transplantation survival prognosis
Kaynakça
- Venook AP, Papandreou C, Furuse J, de Guevara LL. The incidence and epidemiology of hepatocellular carcinoma: a global and regional perspective. Oncologist. 2010;15 Suppl 4:5–13.
- Lee HW, Suh K-S. Expansion of the criteria for living donor liver transplantation for hepatocellular carcinoma. Curr Opin Organ Transplant. 2016 Apr;21(2):231–7.
- Lin S, Hoffmann K, Schemmer P. Treatment of hepatocellular carcinoma: a systematic review. Liver Cancer. 2012 Nov;1(3–4):144–58.
- Gunay Y, Guler N, Yaprak O, Dayangac M, Akyildiz M, Altaca G, et al. Living Donor Liver Transplantation Outcomes for Hepatocellular Carcinoma Beyond Milan or UCSF Criteria. Indian J Surg. 2015 Dec;77(Suppl 3):950–6.
- Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009 Jan;10(1):35–43.
- Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996 Mar 14;334(11):693–9.
- Bismuth H, Chiche L, Adam R, Castaing D, Diamond T, Dennison A. Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg. 1993 Aug;218(2):145–51.
- Iwatsuki S, Starzl TE, Sheahan DG, Yokoyama I, Demetris AJ, Todo S, et al. Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg. 1991 Sep;214(3):221–8; discussion 228-229.
- Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, et al. Liver transplantation for hepatocellular carcinoma: Expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001;33(6):1394–403.
- Silva MF, Sherman M. Criteria for liver transplantation for HCC: what should the limits be? J Hepatol. 2011 Nov;55(5):1137–47.
- DuBay D, Sandroussi C, Sandhu L, Cleary S, Guba M, Cattral MS, et al. Liver transplantation for advanced hepatocellular carcinoma using poor tumor differentiation on biopsy as an exclusion criterion. Ann Surg. 2011 Jan;253(1):166–72.
- Yopp AC, Marrero JA, Singal AG. Expansion of Criteria for Liver Transplantation in Hepatocellular Carcinoma: Better Patient Selection or a Slippery Slope? Ann Surg Oncol. 2017 Jul 1;24(7):1758–60.
- Kaido T. Selection Criteria and Current Issues in Liver Transplantation for Hepatocellular Carcinoma. LIC. 2016;5(2):121–7.
- Xu D-W, Wan P, Xia Q. Liver transplantation for hepatocellular carcinoma beyond the Milan criteria: A review. World J Gastroenterol. 2016 Mar 28;22(12):3325–34.
- Bonadio I, Colle I, Geerts A, Smeets P, Berardi G, Praet M, et al. Liver transplantation for hepatocellular carcinoma comparing the Milan, UCSF, and Asan criteria: long-term follow-up of a Western single institutional experience. Clin Transplant. 2015 May;29(5):425–33.
- Sugawara Y, Tamura S, Makuuchi M. Living donor liver transplantation for hepatocellular carcinoma: Tokyo University series. Dig Dis. 2007;25(4):310–2.
- Sapisochin G, Goldaracena N, Laurence JM, Dib M, Barbas A, Ghanekar A, et al. The extended Toronto criteria for liver transplantation in patients with hepatocellular carcinoma: A prospective validation study. Hepatology. 2016;64(6):2077–88.
- Toso C, Asthana S, Bigam DL, Shapiro AMJ, Kneteman NM. Reassessing selection criteria prior to liver transplantation for hepatocellular carcinoma utilizing the Scientific Registry of Transplant Recipients database. Hepatology. 2009 Mar;49(3):832–8.
- Toso C, Meeberg G, Hernandez-Alejandro R, Dufour J-F, Marotta P, Majno P, et al. Total tumor volume and alpha-fetoprotein for selection of transplant candidates with hepatocellular carcinoma: A prospective validation. Hepatology. 2015 Jul;62(1):158–65.
- Hakeem AR, Young RS, Marangoni G, Lodge JPA, Prasad KR. Systematic review: the prognostic role of alpha-fetoprotein following liver transplantation for hepatocellular carcinoma. Aliment Pharmacol Ther. 2012 May;35(9):987–99.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Aralık 2020 |
| Gönderilme Tarihi | 30 Mart 2020 |
| Yayımlandığı Sayı | Yıl 2020 |