科研之友
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摘要
In selected patients, locoregional therapy (LRT) has been successful in downstaging advanced hepatocellular carcinoma (HCC) so that the conventional criteria for liver transplantation (LT) can be met However, the factors that predict successful treatment are largely unidentified To determine these factors, we analyzed our experience with multimodal LRT in downstaging advanced HCC before LT in a retrospective cohort study. Thirty-two patients with advanced HCC exceeding conventional and expanded criteria for LT underwent therapy, but only those patients whose tumors were successfully downstaged were considered for LT Eighteen patients (56%) had their tumors successfully downstaged, 14 patients (44%) did not No intergroup differences existed with respect to patient characteristics or the types and number of treatments However, mean alpha-fetoprotein levels were significantly higher in the non-downstaged group than in the downstaged group (P < 0 048), and significantly more patients in the non-downstaged group had infiltrative tumors (P = 0 0001) The median survival time was 42 and 7 months for the downstaged and non-downstaged groups, respectively (P = 0 0006) Fourteen patients (43 3%) underwent LT After a median follow-up period of 35 months (range, 15-50 months) after LT, 2 patients (14 2%) developed tumor recurrence. The Kaplan-Meter survival rates after LT were 92% at 1 year and 75% at 2 years The noninfiltrative expanding tumor type was the sole predictor of successful downstaging and improved outcome on univariate and multivariate analyses. Our study suggests that, in patients with advanced HCC, morphological characteristics of the tumor may predict a good response to downstaging and an improved outcome after LT Liver Transpl 16:289-299, 2010.
- 出版日期2010-3
