CAJ | 학술논문

目的探讨科学、合理的肝癌肝移植受者选择标准,验证“杭州标准”的临床应用价值.方法回顾性分析多中心1163例肝癌肝移植病例资料,比较目前国际上公认的几种肝癌肝移植标准的受益群体特征及预后预测能力.结果 1163例肝癌受者中,符合米兰标准、杭州标准和加州大学旧金山分校(UCSF)标准的受者分别为424例(36.4％)、645例(55.5％)和484例(41.6％).杭州标准和UCSF标准在米兰标准基础上分别拓展了52.1％和14.2％；其中,针对无肝硬化背景肝癌受者,杭州标准能最大程度地拓展受益受者,拓展比例达133.3％.符合米兰标准、杭州标准及UCSF标准的3组受者预后无明显差异(P＞0.05).符合杭州标准的受者术后1、3、5年累积存活率分别为85.9％、73.6％、66.4％,显著高于不符合杭州标准受者的60.7％、26.2％、20.7％(P＜0.01)；符合杭州标准的受者术后1、3、5年无肿瘤复发存活率分别为78.8％、65.1％、60.8％,显著高于不符合杭州标准受者的37.2、20.0％、18.8％ (P＜0.01).结论杭州标准能科学、安全地拓展肝癌肝移植受者的选择标准,并有效预测受者的肝移植预后.
목적 탐토과학、합리적간암간이식수자선택표준,험증“항주표준”적림상응용개치.방법 회고성분석다중심1163례간암간이식병례자료,비교목전국제상공인적궤충간암간이식표준적수익군체특정급예후예측능력.결과 1163례간암수자중,부합미란표준、항주표준화가주대학구금산분교(UCSF)표준적수자분별위424례(36.4％)、645례(55.5％)화484례(41.6％).항주표준화UCSF표준재미란표준기출상분별탁전료52.1％화14.2％；기중,침대무간경화배경간암수자,항주표준능최대정도지탁전수익수자,탁전비례체133.3％.부합미란표준、항주표준급UCSF표준적3조수자예후무명현차이(P＞0.05).부합항주표준적수자술후1、3、5년루적존활솔분별위85.9％、73.6％、66.4％,현저고우불부합항주표준수자적60.7％、26.2％、20.7％(P＜0.01)；부합항주표준적수자술후1、3、5년무종류복발존활솔분별위78.8％、65.1％、60.8％,현저고우불부합항주표준수자적37.2、20.0％、18.8％ (P＜0.01).결론 항주표준능과학、안전지탁전간암간이식수자적선택표준,병유효예측수자적간이식예후.
Objective To explore a valid candidate selecting criteria for liver transplantation (LT) in patients with primary hepatocellular carcinoma (HCC),and to investigate the clinical value of Hangzhou Criteria.Method This study retrospectively reviewed 1163 HCC patients undergoing LT,and the characteristics of recruited recipient population and the prognosis-predicting ability of different criteria were compared.Result In the 1163 recipients,the number of patients fulfilling Milan Criteria,Hangzhou Criteria,and UCSF Criteria was 424 (36.4％),645 (55.5％),and 484(41.6％),retrospectively.Compared to Milan Criteria,Hangzhou Criteria and UCSF Criteria provided an expansion of 52.1％ and 14.2％,respectively.For non-cirrhosis HCC patients,Hangzhou Criteria could provide the largest expansion to the candidate pool,which was 133.3％.For the recipients fulfilling different criteria,the prognosis was comparable.Hangzhou Criteria functioned well in predicting tumor-recurrence.The 1-,3-,and 5-years overall survival rate for patients fulfilling Hangzhou Criteria was significantly higher than that of patients exceeding Hangzhou Criteria (85.9％,73.6％,and 66.4％ versus 60.7％,26.2％,and 20.7％,respectively,P＜0.001).And the1,3,and 5-year tumor-free survival rate for patients fulfilling Hangzhou Criteria was also significantly higher than that of patients exceeding Hangzhou Criteria (78.8％,65.1％,and 60.8％ versus 37.2％,20.0％,and 18.8％,respectively,P＜0.001).Conclusion There is no dispute in the ethics Committee and all the donor's family members about the usage of ECMO.The ECMO support DBCD could well control the warm ischemia,and obtain satisfactory curative effect of transplantation.