Liver resection versus liver transplantation for hepatocellular carcinoma within the Milan criteria based on estimated microvascular invasion risks

作     者：Pinghua Yang Fei Teng Shilei Bai Yong Xia Zhihao Xie Zhangjun Cheng Jun Li Zhengqing Lei Kui Wang Baohua Zhang Tian Yang Xuying Wan Hao Yin Hao Shen Timothy M Pawlik Wan Yee Lau Zhiren Fu Feng Shen 

作者机构：Department of Hepatic Surgery IV and Clinical Research InstituteThe Eastern Hepatobiliary Surgery HospitalNaval Medical UniversityShanghaiP.R.China Department of Liver Surgery and Organ TransplantationThe Changzheng HospitalNaval Medical UniversityShanghaiP.R.China Department of General SurgeryThe Affiliated Zhongda HospitalSoutheast UniversityNanjingJiangsuP.R.China Department of Hepatic Surgery II and Clinical Research InstituteThe Eastern Hepatobiliary Surgery HospitalNaval Medical UniversityShanghaiP.R.China Department of Biliary Surgery IV and Clinical Research InstituteThe Eastern Hepatobiliary Surgery HospitalNaval Medical UniversityShanghaiP.R.China Department of Chinese Traditional MedicineThe Eastern Hepatobiliary Surgery HospitalNaval Medical UniversityShanghaiP.R.China Department of SurgeryThe Wexner Medical CenterOhio State UniversityColumbusOHUSA Faculty of Medicinethe Chinese University of Hong KongPrince of Wales HospitalShatinNew TerritoriesHong Kong SARChina 

出 版 物：《Gastroenterology Report》 (胃肠病学报道（英文）)

年 卷 期：2023年第11卷第1期

页      面：385-397页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 100214[医学-肿瘤学] 10[医学] 

基　　金：supported by the State Key Project on Infectious Diseases[2018ZX10723204] Project of Shanghai Key Clinical Specialties[SHSLCZDZK02402] Project of Shenkang Hospital Development Center[SHDC2020CR5007,SHDC12019110] Shanghai Science and Technology Innovation Action Plan[21Y11912700] The funders had no role in the study design,data collection,data analysis,interpretation,or writing of the report 

主　　题：hepatocellular carcinoma microvascular invasion liver resection liver transplantation prognosis 

摘      要：Background:Preoperative prediction of microvascular invasion(MVI)in hepatocellular carcinoma(HCC)may optimize individualized treatment *** study aimed to investigate the prognostic differences between HCC patients undergoing liver resection(LR)and liver transplantation(LT)based on predicted MVI ***:We analysed 905 patients who underwent LR,including 524 who underwent anatomical resection(AR)and 117 who underwent LT for HCC within the Milan criteria using propensity score matching.A nomogram model was used to predict preoperative MVI ***:The concordance indices of the nomogram for predicting MVI were 0.809 and 0.838 in patients undergoing LR and LT,*** on an optimal cut-off value of 200 points,the nomogram defined patients as high-or low-risk MVI *** resulted in a lower 5-year recurrence rate and higher 5-year overall survival(OS)rate than LR among the high-risk patients(23.6%vs 73.2%,P0.001;87.8%vs 48.1%,P0.001)and low-risk patients(19.0%vs 45.7%,P0.001;86.5%vs 70.0%,P=0.002).The hazard ratios(HRs)of LT vs LR for recurrence and OS were 0.18(95%confidence interval[CI],0.09–0.37)and 0.12(95%CI,0.04–0.37)among the high-risk patients and 0.37(95%CI,0.21–0.66)and 0.36(95%CI,0.17–0.78)among the low-risk *** also provided a lower 5-year recurrence rate and higher 5-year OS rate than AR among the high-risk patients(24.8%vs 63.5%,P=0.001;86.7%vs 65.7%,P=0.004),with HRs of LT vs AR for recurrence and OS being 0.24(95%CI,0.11–0.53)and 0.17(95%CI,0.06–0.52),*** 5-year recurrence and OS rates between patients undergoing LT and AR were not significantly different in the low-risk patients(19.4%vs 28.3%,P=0.129;85.7%vs 77.8%,P=0.161).Conclusions:LT was superior to LR for patients with HCC within the Milan criteria with a predicted high or low risk of *** significant differences in prognosis were found between LT and AR in patients with a low risk of MVI.