Cấy ghép gan cho ung thư biểu mô gan trên thế giới: Kinh nghiệm tại Đài Loan

Chao-Long Chen1, Allan M. Concejero1
1Liver Transplant Program, and Department of Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Niao-Sung, Taiwan

Tóm tắt

Cấy ghép gan (LT) được coi là "có khả năng chữa khỏi" cho bệnh nhân xơ gan mắc ung thư biểu mô gan (HCC) vì nó loại bỏ ung thư và xóa bỏ xơ gan. Tại Đài Loan, HCC đứng đầu trong số những nguyên nhân gây tử vong do ung thư ở nam giới và đứng thứ 4 ở nữ giới. Các nguyên nhân phổ biến nhất bao gồm xơ gan do virus viêm gan B mạn tính, xơ gan do virus viêm gan C mạn tính và xơ gan do virus viêm gan B kết hợp với virus viêm gan C. Tổng chi phí suốt đời cho viêm gan và HCC tạo ra một gánh nặng đáng kể cho hệ thống chăm sóc sức khỏe Đài Loan. Tỷ lệ sống sót tổng thể được báo cáo (cấy ghép gan từ người sống và người hiến tặng đã qua đời) sau 1 năm và 3 năm cho HCC sau cấy ghép gan ở Đài Loan dao động từ 86 đến 98% và từ 61 đến 96%, tương ứng. Sự xâm lấn mạch máu vi mô không ảnh hưởng đến kết quả của bệnh nhân, nhưng mức alpha-fetoprotein cao >200 ng/ml có thể là yếu tố nguy cơ cho sự tái phát HCC sau khi cấy ghép.

Từ khóa

#Cấy ghép gan #ung thư biểu mô gan #Đài Loan #xơ gan #alpha-fetoprotein

Tài liệu tham khảo

Taiwan Cancer Registry. http://crs.cph.ntu.edu.tw/crs_c/annual.html. Accessed February 2009 Chen DS. Hepatocellular carcinoma. Hepatol Res. 2007;37(Suppl 2):S101–5. Hsieh CR, Kuo CW. Cost of chronic hepatitis B virus infection in Taiwan. J Clin Gastroenterol. 2004;38(Suppl 3):S148–52. Lang HC, Wu JC, Yen SH, Lan CF, Wu SL. The lifetime cost of hepatocellular carcinoma: a claims data analysis from a medical center in Taiwan. Appl Health Econ Health Policy. 2008;6:55–65. Orito E, Mizokami M. Differences of HBV genotypes and hepatocellular carcinoma in Asian countries. Hepatol Res. 2007;37(Suppl 1):S33–5. Tseng TC, Liu CJ, Chen PJ, Lai MY, Lin CL, Kao JH, et al. Subgenotypes of hepatitis B virus genotype C do not correlate with disease progression of chronic hepatitis B in Taiwan. Liver Int. 2007;27:983–8. Jeng JE, Tsai JF, Chuang LY, Ho MS, Lin ZY, Hsieh MY, et al. Tumor necrosis factor-alpha 308.2 polymorphism is associated with advanced hepatic fibrosis and higher risk for hepatocellular carcinoma. Neoplasia. 2007;9:987–92. Hung CH, Chen CH, Lee CM, Wu CM, Hu TH, Wang JH, et al. Association of amino acid variation in the NS5A and E2-PePHD region of hepatitis C virus 1b with hepatocellular carcinoma. Viral Hepat. 2008;15:58–65. Chen CL, Yang HI, Yang WS, Liu CJ, Chen PJ, You SL, et al. Metabolic factors and risk of hepatocellular carcinoma by chronic hepatitis B/C infection: a follow-up study in Taiwan. Gastroenterology. 2008;135:111–21. Lei HJ, Chau GY, Lui WY, Tsay SH, King KL, Loong CC, et al. Prognostic value and clinical relevance of the 6th edition 2002 American Joint Committee on Cancer staging system in patients with respectable hepatocellular carcinoma. J Am Coll Surg. 2006;203:426–35. Chen TW, Chu CM, Yu JC, Chen CJ, Chan DC, Liu YC, et al. Comparison of clinical staging systems in predicting survival of hepatocellular carcinoma patients receiving major or minor hepatectomy. Eur J Surg Oncol. 2007;33:480–7. Wang JH, Changchien CS, Hu TH, Lee CM, Kee KM, Lin CY, et al. The efficacy of treatment schedules according to Barcelona Clinic Liver Cancer staging for hepatocellular carcinoma–survival analysis of 3892 patients. Eur J Cancer. 2008;44:1000–6. Lin CY, Kee KM, Wang JH, Lee CM, Chen CL, Changchien CS, et al. Is the cancer of the liver Italian program system an adequate weighting for survival of hepatocellular carcinoma? Evaluation of intrascore prognostic value among 36 subgroups. Liver Int. 2009;29:74–81. Chen CH, Hu FC, Huang GT, Lee PH, Tsang YM, Cheng AL, et al. Applicability of staging systems for patients with hepatocellular carcinoma is dependent on treatment method—analysis of 2010 Taiwanese patients. Eur J Cancer. 2009;45(9):1630–9. Chang CH, Chau GY, Lui WY, Tsay SH, King KL, Wu CW. Long-term results of hepatic resection for hepatocellular carcinoma originating from the non-cirrhotic liver. Arch Surg. 2004;139:320–5. Ho MC, Huang GT, Tsang YM, Lee PH, Chen DS, Sheu JC, et al. Liver resection improves the survival of patients with multiple hepatocellular carcinomas. Ann Surg Oncol. 2009;16(4):848–55. Concejero A, Chen CL, Wang CC, Wang SH, Lin CC, Liu YW, et al. Living donor liver transplantation for hepatocellular carcinoma: a single center experience in Taiwan. Transplantation. 2008;85:398–406. Huo TI, Wu JC, Lin HC, Lee FY, Hou MC, Huang YH, et al. Determination of the optimal model for end-stage liver disease score in patients with small hepatocellular carcinoma undergoing loco-regional therapy. Liver Transpl. 2004;10:1507–13. Huo TI, Huang YH, Su CW, Lin HC, Chiang JH, Chiou YY, et al. Validation of the HCC-MELD for dropout probability in patients with small hepatocellular carcinoma undergoing locoregional therapy. Clin Transplant. 2008;22:469–75. Sun PL, Chen CL, Hsu SL, Huang TL, Chen TY, Chen YS, et al. The significance of transarterial embolization for advanced hepatocellular carcinoma in liver transplantation. Transplant Proc. 2004;36:2295–6. Cheng YF, Huang TL, Chen TY, Chen YS, Wang CC, Hsu SL, et al. Impact of pre-operative transarterial embolization on the treatment of hepatocellular carcinoma with liver transplantation. World J Gastroenterol. 2005;11:1433–8. Cheng SJ, Pratt DS, Freeman RB Jr, Kaplan MM, Wong JB. Living-donor versus cadaveric liver transplantation for non-resectable small hepatocellular carcinoma and compensated cirrhosis: a decision analysis. Transplantation. 2001;72:861–8. Sarasin FP, Majno PE, Llovet JM, Bruix J, Mentha G, Hadengue A. Living donor liver transplantation for early hepatocellular carcinoma: a life-expectancy and cost-effectiveness perspective. Hepatology. 2001;33:1073–9. Gondolesi G, Munoz L, Matsumoto C, Fishbein T, Sheiner P, Emre S, et al. Hepatocellular carcinoma: a prime indication for living donor liver transplantation. J Gastrointest Surg. 2002;6:102–7. Lo CM, Fan ST, Liu CL, Chan SC, Ng IO, Wong J. Living donor versus deceased donor liver transplantation for early irresectable hepatocellular carcinoma. Br J Surg. 2007;94:78–86. Ho MC, Wu YM, Hu RH, Ko WJ, Yang PM, Lai MY, et al. Liver transplantation for patients with hepatocellular carcinoma. Transplant Proc. 2004;36:2291–2. Lin NC, Hsia CY, Loong CC, Liu CS, Tsai HL, Lui WY, et al. Liver transplantation at a small-volume procedure center-preliminary results from Taipei Veterans General Hospital. J Chin Med Assoc. 2008;71:186–90. Hu RH, Ho MC, Wu YM, Yu SC, Lee PH. Feasibility of salvage liver transplantation for patients with recurrent hepatocellular carcinoma. Clin Transplant. 2005;19:175–80. Hsieh CB, Chou SJ, Shih ML, Chu HC, Chu CH, Yu JC, et al. Preliminary experience with gemcitabine and cisplatin adjuvant chemotherapy after liver transplantation for hepatocellular carcinoma. Eur J Surg Oncol. 2008;34:906–10. Chen SY, Lin CH, Yu JC, Yu CY, Hsieh CB. Recurrence of hepatocellular carcinoma after liver transplantation presenting as anastomotic stricture. Rev Esp Enferm Dig. 2008;100:434–6. Cheng HT, Chang YH, Chen YY, Lee TH, Tai DI, Lin DY. AFP-L3 in chronic liver diseases with persistent elevation of alpha-fetoprotein. J Chin Med Assoc. 2007;70(8):310–7. Huo TI, Huang YH, Chiang JH, Wu JC, Lee PC, Chi CW, et al. Survival impact of delayed treatment in patients with hepatocellular carcinoma undergoing locoregional therapy: is there a lead-time bias? Scand J Gastroenterol. 2007;42:485–92.