한국간담췌외과학회지 (Annals of Hepato-Biliary-Pancreatic Surgery)

  • 제14권1호
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  • Pages.30-36
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  • 2010
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  • 2508-5778(pISSN)
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  • 2508-5859(eISSN)
한국간담췌외과학회 (The Korean Association of Hepato-Biliary-Pancreatic Surgery)
권호 표지

이식 가능한 간암에 대한 간절제술과 뇌사자 간이식의 비교: 치료의향분석

Liver Resection Versus Transplantation for Hepatocellular Carcinoma within Milan Criteria: An Intention-to-treat Analysis

  • 나양원 (울산대학교 의과대학 울산대학교병원 외과학교실) ;
  • 남창우 (울산대학교 의과대학 울산대학교병원 외과학교실) ;
  • 박능화 (울산대학교 의과대학 울산대학교병원 내과학교실) ;
  • 신정우 (울산대학교 의과대학 울산대학교병원 내과학교실)
  • Nah, Yang-Won (Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Nam, Chang-Woo (Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Park, Neung-Hwa (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Shin, Jung-Woo (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine)
  • 발행 : 2010.03.30
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Postoperative as well as intention-to-treat outcomes of deceased donor liver transplantation (DDLT) for patients with hepatocellular carcinoma (HCC) within the Milan criteria were compared to outcomes for patients who underwent liver resection. The goal was to select the optimal therapeutic option for these patients. Methods: Among 1363 patients diagnosed with HCC between Jan 2001 and Sep 2008, 57 underwent liver resection for HCC within the Milan criteria (LRX group) and 47 registered for DDLT (WAIT group). Thirteen patients underwent DDLT (LTX group), including 2 salvage DDLT for recurrent HCC after resection. The outcomes for the LRX group were compared with those for the LTX and WAIT groups. Results: Child class B or C patients accounted for 5% in the LRX group and 81% in the WAIT group (p=0.000). Among 47 registrants in the WAIT group, 11 underwent DDLT after a mean waiting time of 282 days (LTX group). Tweleve patients were dropped from the waitlist due to death or disease progression after a mean time of 317 days after registration. There was 1 operative death in the LTX group 14 days after DDLT due to primary graft nonfunction. The 3-year overall and disease-free survival rates were comparable between the LRX and LTX groups. On the other hand, the LRX group showed a significantly better intention-to-treat outcome than the WAIT group. The 3-year survival rates were 80.4% for the LRX group and 52.0% for the WAIT group (p=0.002). Conclusion: For HCC patients within the Milan criteria, liver resection should be considered as their primary option of treatment in Korea, where the DDLT rate is below 6%.

키워드

참고문헌

  1. Schwartz M. Liver transplantation for hepatocellular carcinoma. Gastroenterol 2004;127(5 Suppl 1):S268-276. https://doi.org/10.1053/j.gastro.2004.09.041
  2. Ishizaki Y, Kawasaki S. The evolution of liver transplantation for hepatocellular carcinoma (past, present, and future). J Gastroenterol 2008;43:18-26. https://doi.org/10.1007/s00535-007-2141-x
  3. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinoma in patients with cirrhosis. N Engl J Med 1996;334:693-699. https://doi.org/10.1056/NEJM199603143341104
  4. Ravaioli M, Ercolani G, Cescon M, et al. Liver transplantation for hepatocellular carcinoma: further considerations on selection criteria. Liver Transpl 2004;10:1195-1202. https://doi.org/10.1002/lt.20239
  5. Benckert C, Jonas S, Thelen A, et al. Liver transplantation for hepatocellular carcinoma in cirrhosis: prognostic parameters. Transpl Proc 2005;37:1693-1694. https://doi.org/10.1016/j.transproceed.2005.03.143
  6. Korean Liver Cancer Study Group and National Cancer Center, Korea. Practice guidelines for management of hepatocellular carcinoma 2009. Korean J Hepatol 2009;15: 391-423. https://doi.org/10.3350/kjhep.2009.15.3.391
  7. Mazzaferro V, Chun YS, Poon RT, et al. Liver transplantation for hepatocellular carcinoma. Ann Surg Oncol 2008;15:1001- 1007. https://doi.org/10.1245/s10434-007-9559-5
  8. Yao F, Bass NM, Nikolai B, et al. Liver transplantation for hepatocellular carcinoma: analysis of survival according to the intention-to-treat principle and dropout from the waiting list. Liver Transpl 2002;8:873-883. https://doi.org/10.1053/jlts.2002.34923
  9. 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 Transpl 2008;14: 935-945. https://doi.org/10.1002/lt.21445
  10. Fan J, Yang GS, Fu ZR, et al. Liver transplantation outcomes in 1,078 hepatocellular carcinoma patients: a multi-center experience in Shanghai, China. J Cancer Res Clin Oncol 2009;135:1403-1412. https://doi.org/10.1007/s00432-009-0584-6
  11. Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 1999;30:1434-1440. https://doi.org/10.1002/hep.510300629
  12. Lee S, Ahn C, Ha T, et al. Liver transplantation for hepatocellular carcinoma: Korean experience. J Hepatobiliary Pancreat Surg 2009.
  13. Maddala YK, Stadheim L, Andrews JC, et al. Drop-out rates of patients with hepatocellular cancer listed for liver transplantation: outcome with chemoembolization. Liver Transpl 2004;10:449-455. https://doi.org/10.1002/lt.20099
  14. Pierie JP, Muzikansky A, Tanabe KK, Ott MJ. The outcome of surgical resection versus assignment to the liver transplant waiting list for hepatocellular carcinoma. Ann Surg Oncol 2005;12:552-560. https://doi.org/10.1245/ASO.2004.03.029
  15. Poon RT, Fan ST, Lo CM, Liu CL, Wong J. Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg 2002;235:373-382. https://doi.org/10.1097/00000658-200203000-00009
  16. Cha CH, Ruo L, Fong Y, et al. Resection of hepatocellular carcinoma in patients otherwise eligible for transplantation. Ann Surg 2003;238:315-321.
  17. Cillo U, Vitale A, Brolese A, et al. Partial hepatectomy as first-line treatment for patients with hepatocellular carcinoma. J Surg Oncol 2007;95:213-220. https://doi.org/10.1002/jso.20641
  18. Cherqui D, Laurent A, Mocellin N, et al. Liver resection for transplantable hepatocellular carcinoma: long-term survival and role of secondary liver transplantation. Ann Surg 2009;250:738-746. https://doi.org/10.1097/SLA.0b013e3181bd582b
  19. 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 transplantations. Liver Transpl 2005;11:1265-1272. https://doi.org/10.1002/lt.20549
  20. Zimmerman MA, Ghobroal RM, Tong MJ, et al. Recurrence of hepatocellular carcinoma following liver transplantation: a review of preoperative and postoperative prognostic indicators. Arch Surg 2008;143:182-188. https://doi.org/10.1001/archsurg.2007.39
  21. Wang HJ, Lee H. Surgical treatment of hepatocellular carcinoma. Korean J Gastroenterol 2005;45:247-257.
  22. Adam R, Azoulay D, Castaing D, et al. Liver resection as a bridge to transplantation for hepatocellular carcinoma on cirrhosis: a reasonable strategy? Ann Surg 2003;238:508-518.
  23. Belghiti J, Cortes A, Abdalla EK, et al. Resection prior to liver transplantation for hepatocellular carcinoma. Ann Surg 2003; 238:885-892. https://doi.org/10.1097/01.sla.0000098621.74851.65
  24. Del Gaudio M, Ercolani G, Ravaioli M, et al. Liver transplantation for recurrent hepatocellular carcinoma on cirrhosis after liver resection: university of Bologna experience. Am J Transplant 2008;8:1177-1185. https://doi.org/10.1111/j.1600-6143.2008.02229.x
  25. Poon RT. Optimal initial treatment for early hepatocellular carcinoma in patients with preserved liver function: transplantation or resection? Ann Surg Oncol 2007;2:541-547.
  26. Sharma P, Balan V, Hernandez JL, et al. Liver transplantation for hepatocellular carcinoma: the MELD impact. Liver Transpl 2004;10:36-41. https://doi.org/10.1002/lt.20012
  27. Freeman RB, Wiesner RH, Edwards E, Harper A, Merion R, Wolfe R. United Network for Organ Sharing Organ Procurement and Transplantation Network Liver and Transplantation Committee. Results of the first year of the new liver allocation plan. Liver Transpl 2004;10:7-15. https://doi.org/10.1002/lt.20024
  28. Freeman RB Jr, Steffick DE, Guidinger MK, Farmer DG, Berg CL, Merion RM. Liver and intestine transplantation in the United States, 1997-2006. Am J Transplant 2008;8:958-976. https://doi.org/10.1111/j.1600-6143.2008.02174.x