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肝癌肝移植的米兰外标准
LONGTERMRESULTSOFLIVERTRANSPLANTATIONANDMULTIMODALADJUVANTTHERAPYFORTHETREATMENTOFHEPATOCELLULARCARCINOMALARGERTHAN5CMSasanRoayaie,SukruEmre,ThomasFishbein,PatriciaSheiner,CharlesMiller,andMyronSchwartzTheRecanati-MillerTransplantationInstituteMountSinaiMedicalCenterNewYork,NYAnnalsofSurgeryVol.235,No.4533-539April,2002
Background:HCCmostcommonsolidorgantumorworldwideonemilliondeathsannuallyincidencerisinginUS2.4per100,000goodsurvivalwithtransplantfortumors?5cm75%at4yearspoorsurvivalwithtransplantfortumors?5cm18-30%at5years
PreviousStudies
CandidateEntryCriteriaunresectableHCC?5cmfreeofextrahepaticdiseaseCTchest,abdomenpelvisbonescanpatentmajorhepaticmainportalveinsmulticentrictumorsnotexcludedlargesttumorinlessinvolvedlobe5cmtumorinvolving75%parenchyma
EntryCriterianosignificantascitesorencephalopathyINR1.5creatinine2mg/dlbilirubin2mg/dlunlesssufferingfromcholestaticliverdiseasenormalMUGAnopriorchemotherapyorradiation
PretransplantManagementsubselectivearterialchemoembolizationmitomycin-C,doxorubicin,cisplatincollagenorpolyvinylalcoholCTscanAFPlevelevery3monthsresponse-AFPdecrease50%TACErepeatedasneededexcludedwhenentrycriterianolongermet
Intra-OperativeProtocolbackuprecipientinhospitalexploratorylaparotomyforextrahepaticdiseasestandardhepatectomyandtransplantdoxorubicin10mg/m2whileanhepatic
Post-transplantProtocolchemotherapybeginning6thpostopweekdoxorubicin50mg/m2G-CSF5μg/kgfor14daysrepeatedastoleratedevery3weeksx6cyclesimmunosuppressioncorticosteroidswithcyclosporineortacrolimuspulsesteroids±OKT3forrejectionnoazathioprine
Follow-upCTscanchestandabdomen/pelvisevery3months-1styearevery6monthsthereafterAFPevery6weeks-1styearevery3monthsthereafter
ResultsOctober1991-January199980patientsenrolled43transplanted37eventuallyexcl
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