First hepatectomy beyond the Milan criteria affects the prognosis of salvage liver transplantation
10.3760/cma.j.cn113884-20230731-00018
- VernacularTitle:首次肝癌切除时不符合米兰标准影响补救性肝移植预后
- Author:
Yingpeng YE
1
;
Yong YANG
;
Hongda ZHU
;
Fei FENG
;
Shengdong WU
;
Caide LU
;
Jiongze FANG
Author Information
1. 宁波大学附属李惠利医院肝胆胰外科，宁波 315041
- Keywords:
Carcinoma, hepatocellular;
Milan criteria;
Salvage liver transplantation
- From:
Chinese Journal of Hepatobiliary Surgery
2023;29(11):813-819
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the prognostic factors affecting salvage liver transplantation (SLT).Methods:The clinical data of 97 patients undergoing liver transplantation in the Ningbo Medical Centre Lihuili Hospital from January 2012 to May 2022 were retrospectively analyzed, including 84 males and 13 females, aged (53.6±7.4) years. Among them, 33 patients underwent primary liver transplantation (PLT) and 64 underwent SLT. SLT patients were subdivided into the groups within the Milan criteria (SLT-A, n=35) and beyond the Milan criteria (SLT-B, n=29), according to whether the Milan criteria were met at first hepatectomy. Clinicopathological and prognostic data were subsequently analyzed. Results:The tumor number ( χ2=16.03, P<0.001), microvascular invasion (MVI) ( χ2=10.97, P=0.004), recurrence rate ( χ2=9.31, P=0.010), recurrence-free survival (RFS, F=14.05, P=0.001) and overall survival (OS, F=17.27, P<0.001) were significantly different among the three groups. RFS ( P=0.047) and OS ( P=0.012) in PLT group were better than those in SLT-B group. RFS ( P=0.007) and OS ( P=0.024) in SLT-A group were also better than those in SLT-B group. The multivariate analysis indicated that beyond the Milan criteria at first hepatectomy was an independent risk factor for RFS ( HR=4.378, 95% CI: 1.393-13.756, P=0.011) and OS ( HR=5.391, 95% CI: 1.428-20.352, P=0.013) in patients undergoing SLT, and MVI positive ( HR=4.042, 95% CI: 1.137-14.368, P=0.031) was an independent risk factor for RFS in patients undergoing SLT. Conclusion:Patients beyond the Milan criteria at first hepatectomy and MVI positive showed a poorer prognosis after SLT. Whether the Milan criteria should be the gold standard for SLT as well as for PLT needs further study.
