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Результаты трансплантации печени при гепатоцеллюлярном раке: опыт одного центра

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Цель. Оценить отдаленные результаты трансплантации печени при гепатоцеллюлярном раке, провести анализ факторов риска рецидива опухоли. Материал и методы. Проведен ретроспективный анализ 63 трансплантаций печени от посмертного донора с января 2010 по февраль 2020 г. Пациенты разделены на три группы по соответствию Миланским и Калифорнийским критериям - в пределах Миланских критериев, за пределами Миланских критериев, но в пределах Калифорнийских критериев, за пределами Калифорнийских критериев. Результаты. В рамках Миланских критериев было 33 реципиента, в рамках Калифорнийских критериев - 5, вне Калифорнийских критериев - 25. Частота рецидива рака в течение пяти лет наблюдения составила 9,1, 40 и 52% соответственно (p = 0,002), пятилетняя выживаемость - 93,2, 66,7 и 54,7% (p = 0,041). Факторы, ассоциированные с повышенным риском рецидива: ?5 опухолевых узлов (ОР = 3,675; 95% ДИ (1,35-9,97); p = 0,011), макрососудистая инвазия (ОР = 5,97; 95% ДИ (2,06-17,31); p = 0,001) и несоответствие Калифорнийским критериям (ОР = 4,00; 95% ДИ (1,49-10,74); p = 0,006). Факторы, ассоциированные с меньшей частотой рецидива: 1-2 опухолевых узла (p = 0,014 и 0,042 соответственно), высокая степень гистологической дифференцировки (ОР = 0,24; 95% ДИ (0,06-0,93); p = 0,039), соответствие Миланским критериям (ОР = 0,18; 95% ДИ (0,06-0,58); p = 0,004). Заключение. Трансплантация печени может быть выполнена ряду пациентов, не соответствующих Миланским и Калифорнийским критериям. Важную роль в успехе лечения играют морфологические и биологические характеристики опухоли, дифференцированный мультидисциплинарный подход к лечению.

Ключевые слова:
печень, гепатоцеллюлярный рак, трансплантация, Миланские критерии, Калифорнийские критерии, отдаленные результаты, liver, hepatocellular carcinoma, liver transplantation, Milan criteria, California criteria, long-term results

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Outcomes of liver transplantation in hepatocellular carcinoma: a single-center experience

Aim. To evaluate the long-term results of liver transplantation for hepatocellular carcinoma. To perform an analysis of risk factors for tumor recurrence. Materials and methods. A retrospective analysis of 63 deceased donor liver transplantations, which were performed from January 2010 to February 2020. Patients were divided into three groups according to the Milan and California criteria - within the Milan criteria, outside the Milan criteria, but within the California criteria, outside the California criteria. Results. There were 33 recipients within the Milan criteria, 5 within the California criteria, and 25 outside the California criteria. The 5-years recurrence rate was 9.1%, 40% and 52%, respectively (p = 0.002), five-year survival rate of - 93.2%, 66.7% and 54.7% (p = 0.041). Factors associated with an increased risk of recurrence: five and more tumor nodes (OR = 3.675; 95% CI (1.35-9.97); p = 0.011), macroscopic vascular invasion (OR = 5.97; 95% CI (2.06-17.31); p = 0.001) and inconsistency with California criteria (OR = 4.00; 95% CI (1.49-10.74); p = 0.006). The factors associated with a lower recurrence rate: one or two tumor nodes (p = 0.014 and 0.042, respectively), a high grade of histological differentiation (RR = 0.24; 95% CI (0.06-0.93); p = 0.039), compliance with Milanese criteria (RR = 0.18; 95% CI (0.06-0.58); p = 0.004). Conclusion. Liver transplantation can be performed in a number of patients beyond the Milan and California criteria. The morphological and biological characteristics of the tumor and a multidisciplinary differentiated approach to treatment have an important role in the success of treatment.

Keywords:
печень, гепатоцеллюлярный рак, трансплантация, Миланские критерии, Калифорнийские критерии, отдаленные результаты, liver, hepatocellular carcinoma, liver transplantation, Milan criteria, California criteria, long-term results