TY - JOUR
T1 - Comparison of Salvage Living Donor Liver Transplantation and Local Regional Therapy for Recurrent Hepatocellular Carcinoma
AU - Yong, Chee Chien
AU - Tsai, Ming Chao
AU - Lin, Chih Che
AU - Wang, Chih Chi
AU - Lu, Sheng Nan
AU - Hung, Chao Hung
AU - Hu, Tsung Hui
AU - Chen, Chao Long
N1 - Publisher Copyright:
© 2016, Société Internationale de Chirurgie.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Background and aims: Salvage liver transplantation (LT) provides definite treatment for recurrent hepatocellular carcinoma (HCC) after primary liver resection. However, salvage living donor LT (SLDLT) involves more surgical difficulty, compared to local regional therapy (LRT). The optimal treatment strategy remains unclear. This study aims to compare the survival between SLDLT and LRT for patients with recurrent HCC after primary hepatic resection in a single center. Methods: Between 2001 and 2010, 211 patients with recurrent HCC after primary liver resection and a certain Milan criteria were enrolled. Among these patients, 41 and 170 patients received SLDLT and LRT, respectively. Clinical parameters were analyzed in terms of overall survival by multivariate analysis. Results: The 1-, 3-, and 5-year overall survival rates were 90.2, 80.4, and 80.4 % in the SLDLT group, and 91.6, 71.7, and 51.1 % in LRT group, respectively. A paradoxical phenomenon of survival was noticed—a poorer survival rate within the first year in the SLDLT group but a better one after that year. For patients who survived more than 1 year, the SLDLT led to significantly better survival outcomes than LRT (P < 0.001). In multivariate analysis, SLDLT and alpha-fetoprotein (AFP) level < 200 ng/ml at recurrence were associated with better survival. Conclusions: To manage recurrent HCC, SLDLT with reasonable surgical mortality provided better long-term survival. AFP is an independent risk factor for overall survival.
AB - Background and aims: Salvage liver transplantation (LT) provides definite treatment for recurrent hepatocellular carcinoma (HCC) after primary liver resection. However, salvage living donor LT (SLDLT) involves more surgical difficulty, compared to local regional therapy (LRT). The optimal treatment strategy remains unclear. This study aims to compare the survival between SLDLT and LRT for patients with recurrent HCC after primary hepatic resection in a single center. Methods: Between 2001 and 2010, 211 patients with recurrent HCC after primary liver resection and a certain Milan criteria were enrolled. Among these patients, 41 and 170 patients received SLDLT and LRT, respectively. Clinical parameters were analyzed in terms of overall survival by multivariate analysis. Results: The 1-, 3-, and 5-year overall survival rates were 90.2, 80.4, and 80.4 % in the SLDLT group, and 91.6, 71.7, and 51.1 % in LRT group, respectively. A paradoxical phenomenon of survival was noticed—a poorer survival rate within the first year in the SLDLT group but a better one after that year. For patients who survived more than 1 year, the SLDLT led to significantly better survival outcomes than LRT (P < 0.001). In multivariate analysis, SLDLT and alpha-fetoprotein (AFP) level < 200 ng/ml at recurrence were associated with better survival. Conclusions: To manage recurrent HCC, SLDLT with reasonable surgical mortality provided better long-term survival. AFP is an independent risk factor for overall survival.
UR - https://www.scopus.com/pages/publications/84969800091
U2 - 10.1007/s00268-016-3559-1
DO - 10.1007/s00268-016-3559-1
M3 - 文章
C2 - 27194562
AN - SCOPUS:84969800091
SN - 0364-2313
VL - 40
SP - 2472
EP - 2480
JO - World Journal of Surgery
JF - World Journal of Surgery
IS - 10
ER -
