肝癌肝移植的米兰外标准课件

肝癌肝移植的米兰外标准LONGTERMRESULTSOFLIVERTRANSPLANTATIONANDMULTIMODALADJUVANTTHERAPYFORTHETREATMENTOFHEPATOCELLULARCARCINOMALARGERTHAN5CMSasanRoayaie,SukruEmre,ThomasFishbein,PatriciaSheiner,CharlesMiller,andMyronSchwartzTheRecanati-MillerTransplantationInstituteMountSinaiMedicalCenterNewYork,NYAnnalsofSurgeryVol.235,No.4533-539April,2002Thispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesBackground:HCCmostcommonsolidorgantumorworldwideonemilliondeathsannuallyincidencerisinginUS2.4per100,000goodsurvivalwithtransplantfortumors

5cm75%at4yearspoorsurvivalwithtransplantfortumors

5cm18-30%at5yearsThispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesPreviousStudiesThispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesCandidateEntryCriteriaunresectableHCC5cmfreeofextrahepaticdiseaseCTchest,abdomen&pelvisbonescanpatentmajorhepatic&mainportalveinsmulticentrictumorsnotexcludedlargesttumorinlessinvolvedlobe<5cmtumorinvolving<75%parenchymaThispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesEntryCriterianosignificantascitesorencephalopathyINR<1.5creatinine<2mg/dlbilirubin<2mg/dlunlesssufferingfromcholestaticliverdiseasenormalMUGAnopriorchemotherapyorradiationThispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesPretransplantManagementsubselectivearterialchemoembolizationmitomycin-C,doxorubicin,cisplatincollagenorpolyvinylalcoholCTscan&AFPlevelevery3monthsresponse-AFPdecrease>50%TACErepeatedasneededexcludedwhenentrycriterianolongermetThispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesIntra-OperativeProtocolbackuprecipientinhospitalexploratorylaparotomyforextrahepaticdiseasestandardhepatectomyandtransplantdoxorubicin10mg/m2whileanhepaticThispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesPost-transplantProtocolThispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesFollow-upCTscanchestandabdomen/pelvisevery3months-1styearevery6monthsthereafterAFPevery6weeks-1styearevery3monthsthereafterThispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesResultsdistantmetastasis- 6GIbleeding- 4othermalignancies- 2patientpreference- 3Thispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesThispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesTumorCharacteristicsThispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesUnderlyingLiverDiseaseThispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesComplicationsTACE2/80(2.5%)mortalityfromliverfailureperioperativemortality2/43(4.7%)chemotherapymean4.8±1.79cycles4/43(9.3%)didnotreceiveanypostopchemo2perioperativemortalities1patientrefusal1poorpostopcardiacfunctionThispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesComplicationsChemotherapydiscontinuedearly3(7%)thrombocytopenia2(5%)hepatotoxicity4(9%)progressiverecurrenttumor2(5%)refusaltocontinueThispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesFollow-upmedianfollow-up55.1±24.9mo.19/43(44%)alive17/43(40%)freeofdiseaserecurrencein17/43(40%)mediantimetorecurrence12.5±12.6mo.intrahepaticonly 2extrahepaticonly 9both 5riseinAFP 1Thispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesmonths60483624120overallsurvival1.0.9.8.7.6.5.4.3.2.10.0transplantedexcludedOverallSurvival44%p<0.0001Thispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesmonths60483624120recurrencefreesurvival1.0.9.8.7.6.5.4.3.2.10.0Recurrence-freeSurvival48%Thispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesRecurrence:tumorsizep=0.024Thispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesmonths60483624120recurrencefreesurvival1.0.9.8.7.6.5.4.3.2.10.0tumors5-7cmtumors>7cmRecurrence-freesurvival55%34%p=0.0237Thispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesRecurrence:vascularinvasionp=0.036Thispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesmonths60483624120recurrencefreesurvival1.0.9.8.7.6.5.4.3.2.10.0novascularinvasionmicro-ormacro-Recurrence-freeSurvivalp=0.101Thispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesmonths60483624120recurrencefreesurvival1.0.9.8.7.6.5.4.3.2.10.0wellormoderatelydifferentiatedpoorlydifferentiatedRecurrence-freesurvivalP=0.147Thispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,researchcitationsandanalysesmonths60483624120recurrencefreesurvival1.0.9.8.7.6.5.4.3.2.10.0hepatitisBotherliverdiseaseRecurrence-freesurvivalp=0.136Thispresentationisreproducedonthissitewiththepermissionoftheauthor(s).Allopinions,resear