Clinical effects of comprehensive treatment and liver transplantation for hepatocellular carcinoma exceeding Milan criteria:a comparative study / 临床肝胆病杂志

ABSTRACT

Objective To analyze and compare the clinical effects of comprehensive treatment and liver transplantation for hepatocellular carcinomas (HCC)exceeding Milan criteria.Methods A retrospective analysis was performed on the clinical data of 157 patients with HCC (exceeding Milan criteria)who received comprehensive treatment (99 patients,including 48 cases meeting Shanghai criteria)and liv-er transplantation (58 patients,including 26 cases meeting Shanghai criteria)in our hospital from January 2006 to January 2010.The medi-an survival times and 1 -,2-,and 3-year survival rates were calculated by the Kaplan-Meier method,and the log-rank test was used for survival difference analysis.Results For all patients,the median survival times of the comprehensive treatment group and liver trans-plantation group were 18.00 ±1.15 and 23.40 ±4.44 months,respectively,and their 3 -year survival rates were(18.2 ±3.9)% and (39.7 ±6.4)%,respectively;the survival was significantly improved by the treatment of liver transplantation (P=0.009).For patients meeting Shanghai criteria,the median survival times of the comprehensive treatment group and liver transplantation group were 20.00 ±1.17 and 36.00 ±0.00 months,respectively,and their 3-year survival rates were (25.0 ±6.3)% and (57.7 ±9.7)%,respectively;there was significant survival difference between the two groups (P=0.008).For patients exceeding Shanghai criteria,the median survival times of the comprehensive treatment group and liver transplantation group were 16.00 ±1.78 and 16.00 ±1.69 months,respectively,and their 3-year survival rates were (11.8 ±4.5)% and (25.0 ±7.7)%,respectively;there was no significant survival difference between the two groups (P=0.221).Conclusion Compared with comprehensive treatment,liver transplantation leads to a significant higher long-term survival rate in HCC patients exceeding Milan criteria but meeting Shanghai criteria.However,the two therapies cause no significant survival difference in HCC patients exceeding Shanghai criteria.