Comparative analysis of patients transplanted due to hepatocellular carcinoma. Are there survival differences between those who meet the Milan criteria and those who exceed them?
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引用次数: 0
Abstract
Introduction and aim
The Milan criteria have been the subject of discussion in recent years due to their restrictive nature. Expansion of the criteria and the use of locoregional therapies to downstage patients and increase the number of transplant candidates have been proposed. Our study analyzed the results of patients that underwent transplant due to hepatocellular carcinoma, comparing those that met the Milan criteria and those that exceeded them.
Materials and methods
A retrospective, observational, single-center study was conducted on liver transplantations due to hepatocellular carcinoma, within the time frame of 2010−2021. Demographic and clinical variables, overall survival, and disease-free survival were analyzed. The Student’s t test or Mann–Whitney U test were applied for the quantitative variables and the Fisher’s exact test for the categorical variables. The survival function was estimated through the Kaplan–Meier method and the log-rank test was applied for comparing the groups.
Results
Of the 96 transplanted patients, 78 met the Milan criteria and 18 exceeded them. Patients that did not meet the Milan criteria had a higher number of nodules (1.6 vs. 3.5 nodules; p = 0.000), larger main lesions (24.38 vs. 38.55 mm; p = 0.000), a higher bilobar hepatocellular carcinoma rate (21.79% vs. 72.22%, p = 0.000), and higher tumor burden. There were no significant differences regarding overall survival, but there was a lower rate of disease-free survival in the group exceeding the criteria.
Conclusion
Downstaged patients that received locoregional therapies had lower disease-free survival rates than patients that met the Milan criteria, but there were no significant differences regarding overall survival.
米兰标准由于其限制性,近年来一直是讨论的主题。已经提出了扩大标准和使用局部治疗来降低患者的阶段并增加移植候选人的数量。我们的研究分析了因肝细胞癌而接受移植的患者的结果,比较了符合米兰标准和超出米兰标准的患者。材料与方法对2010 ~ 2021年肝细胞癌肝移植患者进行回顾性、观察性、单中心研究。分析人口学和临床变量、总生存期和无病生存期。定量变量采用Student’s t检验或Mann-Whitney U检验,分类变量采用Fisher精确检验。生存函数采用Kaplan-Meier法估计,组间比较采用log-rank检验。结果96例移植患者中,78例符合米兰标准,18例超出米兰标准。不符合米兰标准的患者有更高数量的结节(1.6 vs 3.5;P = 0.000),主要病变较大(24.38 vs. 38.55 mm;P = 0.000),更高的双叶肝细胞癌发生率(21.79% vs. 72.22%, P = 0.000)和更高的肿瘤负担。总体生存率没有显著差异,但超过标准组的无病生存率较低。结论接受局部区域治疗的下分期患者的无病生存率低于符合米兰标准的患者,但总体生存率无显著差异。