Prognosis analysis of different selection criteria for liver transplantation recipients with hepatocellular carcinoma

doi:10.3877/cma.j.issn.1674-3903.2019.03.009

Abstract

Abstract:

Objective

To analyze the prognosis of patients with hepatocellular carcinoma who were selected for liver transplantation by different criteria, and then to evaluate the difference between different criteria.

Methods

The clinical data of liver transplantation recipients with hepatocellular carcinoma in Affiliated Beijing Chaoyang Hospital of Captical Medical University from January 2013 to December 2017 were retrospectively analyzed. The recipients were divided into 3 groups according to the selection criteria for liver transplantation recipients with hepatocellular carcinoma. The prognosis of recipients who were selected for liver transplantation by different criteria was compared. One way ANOVO analysis was used to compare the age, operation time, anhepatic time and maximum diameter of tumor between different group. Rank sum test was used to compare AFP, end-stage liver disease model and bleeding volume between different group. Survival curve was drawn by Kaplan-Meier method and survival rate between different group was compared by Log-Rank test. Chi-square test was used to compare the indexes including Child classification and tumor differentiation between different group. P<0.05 means statistically significant.

Results

According to the pathological results of liver transplantation, 43 of 115 liver cancer recipients met Milan criteria, 49 met University of California San Francisco (UCSF) criteria, which was 14.0% more than Milan criteria, 91 met Hangzhou criteria, which was 111.6% more than Milan criteria and 85.7% more than UCSF criteria. Up to December 2017, the average follow-up time and median survival time of 115 recipients were (19±17) months and 41.5 months respectively. Except for the maximum diameter and number of tumor, the recipients among the 3 groups were all comparable (P>0.05). No significant difference was found for 1-4 year overall survival rate and tumor-free survival curves amongthe 3 groups (P all>0.05).

Conclusions

Hangzhou criteria safely enlarges the scope of application of liver transplantation and benefits more patients with hepatocellular carcinoma compared with Milan and UCSF criteria.

Key words: Liver transplantation, Hepatocellular carcinoma, Prognosis, Survival analysis, Hangzhou criteria, Milan criteria, University of California San Francisco criteria

Shaocheng Lyu, Bing Pan, Lixin Li, Ren Lang, Xianliang Li, Hua Fan, Xin Zhao, Qiang He. Prognosis analysis of different selection criteria for liver transplantation recipients with hepatocellular carcinoma[J]. Chinese Journal of Transplantation(Electronic Edition), 2019, 13(03): 206-209.

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References 19

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分组	例数	性别(男/女，例)	年龄(±s岁)	肝炎(是/否，例)	术前治疗^*(是/否，例)	AFP[M(Min，Max)，ng/L]	MELD评分(Min，Max)，ng/mL]
米兰标准	43	39/ 4	54±8	39/ 4	15/28	13.8(4.5, 34.0)	6.3(3.3, 10.2)
UCSF标准	49	45/ 4	55±8	45/ 4	17/32	17.3(4.6, 37.7)	6.3(3.5, 10.0)
杭州标准	91	81/10	54±8	80/11	40/51	13.9(4.7, 45.3)	7.4(4.2, 10.6)
分组	例数	Child分级(A/B/C，例)	手术时间(±s，h)	无肝期时间(±s，min)	出血量[M(Min，Max)，mL]	输血(是/否，例)	分化程度(低/中/高，例)
米兰标准	43	20/19/ 4	8.9±2.0	52±10	1000(600, 1450)	26/17	5/25/13
UCSF标准	49	24/21/ 4	8.8±1.9	53±10	1000(600, 1400)	27/22	7/28/14
杭州标准	91	43/38/10	8.9±1.9	53±11	1000(600, 1550)	56/35	12/59/20
分组	例数	肿瘤最大直径(±s，cm)	肿瘤数目(1/1～3/>3，个)	微血管侵犯(是/否，例)	免疫抑制剂(他克莫司/环孢素，例)	索拉菲尼(是/否，例)
米兰标准	43	2.3±1.0	35/ 8/ 0	11/32	32/11	16/27
UCSF标准	49	2.7±1.4	39/10/ 0	14/35	36/13	17/32
杭州标准	91	3.6±2.3^ab	50/12/29^ab	37/54	71/20	32/59

分组	例数	性别(男/女，例)	年龄(±s岁)	肝炎(是/否，例)	术前治疗^*(是/否，例)	AFP[M(Min，Max)，ng/L]	MELD评分(Min，Max)，ng/mL]
米兰标准	43	39/ 4	54±8	39/ 4	15/28	13.8(4.5, 34.0)	6.3(3.3, 10.2)
UCSF标准	49	45/ 4	55±8	45/ 4	17/32	17.3(4.6, 37.7)	6.3(3.5, 10.0)
杭州标准	91	81/10	54±8	80/11	40/51	13.9(4.7, 45.3)	7.4(4.2, 10.6)
分组	例数	Child分级(A/B/C，例)	手术时间(±s，h)	无肝期时间(±s，min)	出血量[M(Min，Max)，mL]	输血(是/否，例)	分化程度(低/中/高，例)
米兰标准	43	20/19/ 4	8.9±2.0	52±10	1000(600, 1450)	26/17	5/25/13
UCSF标准	49	24/21/ 4	8.8±1.9	53±10	1000(600, 1400)	27/22	7/28/14
杭州标准	91	43/38/10	8.9±1.9	53±11	1000(600, 1550)	56/35	12/59/20
分组	例数	肿瘤最大直径(±s，cm)	肿瘤数目(1/1～3/>3，个)	微血管侵犯(是/否，例)	免疫抑制剂(他克莫司/环孢素，例)	索拉菲尼(是/否，例)
米兰标准	43	2.3±1.0	35/ 8/ 0	11/32	32/11	16/27
UCSF标准	49	2.7±1.4	39/10/ 0	14/35	36/13	17/32
杭州标准	91	3.6±2.3^ab	50/12/29^ab	37/54	71/20	32/59

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