진행성 간암환자에서 간이식 수술의 적응증 확대

Expanded Criteria for Living Donor Liver Transplantation in Patients with Advanced Hepatocellular

  • 이경근 (가톨릭대학교 외과학교실) ;
  • 윤영철 (가톨릭대학교 외과학교실) ;
  • 황정기 (가톨릭대학교 외과학교실) ;
  • 박정현 (가톨릭대학교 외과학교실) ;
  • 김지일 (가톨릭대학교 외과학교실) ;
  • 유영경 (가톨릭대학교 외과학교실) ;
  • 문인성 (가톨릭대학교 외과학교실) ;
  • 김동구 (가톨릭대학교 외과학교실)
  • Lee, Kyung-Keun (Department of Surgery, Catholic University of Korea) ;
  • Youn, Young-Chul (Department of Surgery, Catholic University of Korea) ;
  • Hwang, Jung-Ki (Department of Surgery, Catholic University of Korea) ;
  • Park, Jung-Hyun (Department of Surgery, Catholic University of Korea) ;
  • Kim, Ji-Il (Department of Surgery, Catholic University of Korea) ;
  • Yoo, Yung-Kyung (Department of Surgery, Catholic University of Korea) ;
  • Moon, In-Sung (Department of Surgery, Catholic University of Korea) ;
  • Kim, Dong-Goo (Department of Surgery, Catholic University of Korea)
  • 발행 : 2009.09.30

초록

Purpose: The purpose of this study was to evaluate the possibility of expanding the indication for living donor liver transplantation (LDLT) for treatment of hepatocellular carcinoma (HCC), beyond the Milan criteria without compromising patient survival. Methods: This was a retrospective study of 5patients (36.4%) that had undergone LDLT, beyond the Milan criteria, among 143 patients with HCC. The study was conducted in patients treated by the Department of Surgery, Catholic University of Korea from Oct 2000 to May 2008. We evaluated the survival curve, prognostic factors for survival and compared survival between our new criteria and Milan criteria. Results: The 5 year patient survival and disease free survival rate in patients treated with LDLT beyond the Milan criteria were 50.2% and 61.9%, respectively. The prognostic factors affecting disease free survival and patient survival included serum AFP level, tumor size, vascular invasion, and tumor cell differentiation on univariate analysis. In multivariate analysis, AFP (200 ng/mL), tumor size (7 cm) and vascular invasion had significant influence on survival and disease free survival. According to our new criteria (size <7 cm, AFP <200 ng/mL), 88.1% of our patients were included compare to the 63.6% that would have been if limited to the Milan criteria. With both factors met, the survival was comparable to the survival of Milan criteria (63.7% on our criteria and 78.2% on milan criteria at 5 years) (P=0.103). Conclusion: A tumor size <7 cm and an AFP < 200 ng/mL appear to be useful cut-off values, beyond that criteria required by Milan. An analysis according to our criteria showed an acceptable survival outcome. Further verification of these findings by a large volume or prospective study is required for widespread adoption of our new criteria.

키워드

참고문헌

  1. Iwatsuki S, Starzl TE, Sheahan DG, et al. Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg 1991;214:221-9. https://doi.org/10.1097/00000658-199109000-00005
  2. 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;218:145-51. https://doi.org/10.1097/00000658-199308000-00005
  3. Yokoyama I. Sheahan DG, Carr B, et al. Clinicopathologic factors affection patient survival and tumor recurrence after orthotopc liver transplantation for hepatocellular carcinoma. Transplant Proc 1991;23:2194-6.
  4. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas inpatients with cirrhosis. N Engl J Med 1996;334:693-9. https://doi.org/10.1056/NEJM199603143341104
  5. Yao FY, Bass NM, Nikolai B, et al. A follow-up analysis of the pattern and predictors of dropout from the waiting list for liver transplantation in patients with hepatocellular carcinoma: implications for the current organ allocation policy. Liver TranspI 2003;9:684-92. https://doi.org/10.1053/jlts.2003.50147
  6. Goodman J, Glasgow SC, Schnizler M, et al. Liver transplantation for hepatocellular carcinoma. Arch Surg 2005;140:459-64. https://doi.org/10.1001/archsurg.140.5.459
  7. Roayaie S, Frischer JS, Emre SH, et al. Long-term results with multimodal adjuvant therapy and liver transplantation for the treatment of hepatocellular carcinoma lager than 5 centimeters. Ann Surg 2002;235:533-9. https://doi.org/10.1097/00000658-200204000-00012
  8. Yao FY, Ferrell L, bass M, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 2001;33:1394-403. https://doi.org/10.1053/jhep.2001.24563
  9. Yao FY, Bass NM, Nikolai B, et at. Liver transplantation for hepatocellular carcinoma : analysis of survival according to the intention-to-treat principle and dropout from the waiting list. Liver TrampI 2002;8:873-83.
  10. Herrero JI, Sangro B, Quiroga J, et al. Influence of tumor characteristics on the outcome of liver transplantation among patients with liver cirrhosis and hepatocellularcarcinoma. Liver Transpl 2001;7:631-6. https://doi.org/10.1053/jlts.2001.25458
  11. Onaca N, Davis GL, Goldstein RM, Jennings LW, Klitmalm GB. Expanded criteria for liver transplantation in patients with hepatocellular carcinoma: a report from the International Resgisrty of Hepatic Tumors in Liver Transplantation. Liver TrampI 2007;13:391-9. https://doi.org/10.1002/lt.21095
  12. Hiatt JR, Carmody IC, Busuttil RW. Should we expand the criteria for hepatocellular carcinoma with living donor liver transpalntaion? no, never. J HepatoI 2005;43:573-7. https://doi.org/10.1016/j.jhep.2005.07.017
  13. Decaens T, Roudor-Thoraval F, Hadni- Bresson S. et al. Impact of UCSF criteria according to pre- and post-OLT tumor features: analysis of 479 patients list for HCC with a short waiting time. Liver Transpl 2006;12:1761-9. https://doi.org/10.1002/lt.20884
  14. Bruix J, Llovet J. Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology 2002;35:519-26. https://doi.org/10.1053/jhep.2002.32089
  15. Kaihara S, Kiuchi T, Veda M, et al. Living-donor liver transplantation for hepatocellular carcinoma. Transplantation 2003;75(3 suppl): S37-40.
  16. Todo S, Furukawa H, Japanese Study Group on Organ Transplantation. Living donor liver transplantation for adult patients with hepatocellular carcinoma: experience in japan. Ann Surg 2004;240:451-61. https://doi.org/10.1097/01.sla.0000137129.98894.42
  17. Gondolesi GE, Roayaie S, Munoz L, et al. Adult living donor liver transplantation for patients with hepatocellular carcinoma: extending UNOS priority criteria. Ann Surg 2004;239:142-9. https://doi.org/10.1097/01.sla.0000109022.32391.eb
  18. Hwang S, Lee SG, Joh JW, Suh KS, Kim DG. Liver transplantation for adult patients with hepatocellular carcinoma in korea: comparison between cadaveric donor and living donor liver transplantation. Liver Transpl 2005;11:1265-72. https://doi.org/10.1002/lt.20549
  19. Hae Won Lee, Kyung Suk Suh, Jai Young Cho, et al. Expansion of Indication for Liver Transplantation for the patients with Hepatocellular Carcinoma. Korean Journal of HBP Surgery 2004;8:217-24.
  20. Lee KW, Park JW, Joh JW, et al. Can we expand the Milan criteria for hepatocellular carcinoma in living donor liver transplantation? Transpl Proc 2004;36:2289-90. https://doi.org/10.1016/j.transproceed.2004.08.144
  21. Kaihara S, Kiuchi T, Ueda M, et al. Living-donor liver transplantation for hepatocellular carcinoma. Transplantation 2003;75:S37-40.
  22. Jonas S, Bechstein WO, Steinmuller T, et al. Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis. Hepatologe 2001;33:1080-6. https://doi.org/10.1053/jhep.2001.23561
  23. Soejima Y, Taketomi A, Yoshizumi T, et al. Extended Indication for Living Donor Liver Transplantation in Patients With Hepatocellular carcinoma. Transplantation 2007;83:893-899. https://doi.org/10.1097/01.tp.0000259015.46798.ec
  24. Lee SG, Hwang S, Moon DB, et al. Expanded Indication Criteria of Living Donor Liver Transplantation for Hepatocellular Carcinoma at One Large-Volume Center. Liver Trampl 2008;14:953-945.
  25. Ravaioli M, Ercolani G, Cescon M, et al. Liver transplantation for hepatocellular carcinoma: further considerations on selection criteria. Liver Transpl 2004;10:1195-202. https://doi.org/10.1002/lt.20239
  26. Cillo U, Vitale A, Bassanello M. Liver transplantation for the treatment of moderately or well differentiated hepatocellular carcinoma. Ann Surg. 2004;239:150-9. https://doi.org/10.1097/01.sla.0000109146.72827.76
  27. Yang SH, Suh KS, Lee HW, et al. The role of 18F-FDG-PET imaging for the selection of liver transplantation candidates among hepatocellular carcinoma patients. Liver Tranpl 2006;12:1655-60. https://doi.org/10.1002/lt.20861
  28. Broelsch CE, Frilling A, Malago M. Should we expand the criteria for liver transplantation for hepatocelluar carcinoma-yes. of course! J HepatoI 2005;43:569-73. https://doi.org/10.1016/j.jhep.2005.07.016