背景:Wailitst丢失是一个关键问题,我们研究了肝细胞癌(HCC)患者在肝移植评估候补结果时肝功能储备不足的长期影响。
方法:回顾性收集2014年至2021年期间接受肝移植的HCC患者的临床数据。肝脏储备参数,包括肝硬化,Child-Pugh年级,和终末期肝病模型(MELD)评分,分析了患者的生存率,在调整肿瘤因素后。
结果:在292名符合条件的患者中,94.2%有肝硬化,55.8%有Child-PughB级或C级,MELD评分中位数为13.2分。中位随访时间为2.2年,辍学率为62.7%。89名候选人(30.5%)最终接受了肝脏移植,包括67名来自现场捐赠者。在未接受移植的情况下仍在等待名单上的203名患者中,估计1年死亡率达到40.6%,143人死亡大多数死亡归因于肝衰竭(37.1%)和癌症死亡(35.7%)。在我们调整了肿瘤混杂因素后,包括甲胎蛋白,原发性肝癌分期,评估时的肿瘤数量,在等待之前和期间进行序贯癌症治疗,患者生存的风险比(HR)为1.69(95%置信区间,1.18-2.41)肝硬化B期或C期,MELD分数为1.07(1.04-1.10),移植评估时肿瘤大小为1.14(1.04-1.25)。移植是一种保护性疾病调节剂,调整后的HR为0.22(0.14-0.33)。
结论:肝功能储备不足对肝癌肝移植候补结果的风险高于预期。
BACKGROUND: Wailitst lost is an critical issue and we investigated the long-term effect of insufficient liver functional
reserve at liver transplantation evaluation on waitlist outcomes in patients with hepatocellular carcinoma (HCC).
METHODS: Clinical data of patients with HCC waitlisted for liver transplantation were retrospectively collected from a single hospital cohort during the period from 2014 to 2021. Parameters of liver
reserve, including cirrhosis, Child-Pugh grade, and Model for End-Stage Liver Disease (MELD) scores, were analyzed for patient survival, after adjustment for tumor factors.
RESULTS: Of 292 eligible patients, 94.2% had cirrhosis, 55.8% had Child-Pugh grade B or C, and the median MELD score was 13.2. The median follow-up time was 2.2 years, with a dropout rate of 62.7%. Eighty-nine candidates (30.5%) eventually received liver transplant, including 67 from live donors. The estimated 1-year mortality rate reached 40.6% in 203 patients who remained on the waitlist without receiving a transplant, of whom 143 died. Most deaths were attributed to liver failure (37.1%) and cancer death (35.7%). After we adjusted for tumor confounders, including alpha fetoprotein, primary HCC stage, tumor number at evaluation, and sequential cancer treatment before and while waiting, hazard ratios (HRs) for patient survival were 1.69 (95% confidence interval, 1.18-2.41) for cirrhotic stage B or C, 1.07 (1.04-1.10) for MELD scores, and 1.14 (1.04-1.25) for tumor size at transplant evaluation. Transplantation was a protective disease modifier with adjusted HR 0.22 (0.14-0.33).
CONCLUSIONS: Insufficient liver functional
reserve poses more risk than expected to liver transplant waitlist outcomes with HCC.