| 抄録 |
Nearly all cases of hepatitis C (HCV)-related hepatocellular carcinoma (HCC) occur in patients with advanced fibrosis or cirrhosis, and in patients with HCV cirrhosis HCC is the leading cause of death; the annual incidence of HCC in patients with HCV cirrhosis is in the range of 2-4%. Hepatic resection is not an entirely suitable treatment, both because significant liver dysfunction or portal hypertension are commonly present and result in prohibitive risk, and because intrahepatic spread and de novo tumor development result in a high rate of HCC recurrence. With optimal case selection 5-year survival after resection may reach 70%, but tumor recurrence is also around 70% at 5 years, and as a result survival at 10 years is considerably lower. Liver transplantation holds great appeal since it eliminates both cirrhosis and cancer; indeed, in well-selected cases with HCC within the Milan criteria (one tumor < 5cm, or 2-3 tumors all < 3cm), HCC recurrence is seen in only 10%. Despite the low recurrence rate, however, 5-year patient survival after transplant for HCV-related HCC is not substantially different from that achieved after resection. This is a result of 1) the inherent risks of transplant, with procedure-related mortality within the first year at around 10%; 2) recurrent HCV infection with accelerated progression related to immunosuppression. When viewed on an intention-to-treat basis, including the failure of some patients to receive a transplant due to tumor progression resulting in waiting list drop-out, results of transplantation may actually be inferior to those achieved with resection. As a result, even in centers where transplantation is available, resection remains the treatment of choice for patients with Child’s A cirrhosis, no significant portal hypertension, and a solitary HCC that is situated such that resection way be safely completed. |
