J Hepatol:可预测肝癌患者肝移植后的存活率的风险评分方法

2021-01-20 MedSci原创 MedSci原创

在美国和欧洲,肝移植的优先顺序遵循“病情最重优先”的原则。然而,对于肝细胞癌(肝癌,HCC)患者,优先顺序是基于二元肿瘤标准(如,Milan),以加快对移植预后“可

在美国和欧洲,肝移植的优先顺序遵循“病情最重优先”的原则。然而,对于肝细胞癌(肝癌,HCC)患者,优先顺序是基于二元肿瘤标准(如,Milan),以加快对移植预后“可接受”的患者的移植。为克服这些二元标准的局限性而开发的新风险评分(如,Metroticket、HALT-HCC)不足以用于等待优先顺序,因为它们仅关注了与HCC相关的移植前因素。David等尝试采用HCC相关变量和非HCC相关变量来开发风险评分来预测HCC患者移植后的存活率。

采用2002年2月27日-2018年12月31日期间接受已故供者来源的肝移植(DDLT)的患者的国家登记数据进行回顾性队列研究。以5年和10年存活率为重点进行Cox回归模型分析,使用手动变量选择来估计风险分数的β系数,计算绝对预测生存时间,并将其与现有的风险分数进行比较。

不同得分患者的移植后存活概率

在6502例进行肝移植的成年肝癌患者中,最终模型(LiTES-HCC)纳入了11个变量。5年和10年的AUC分别为0.62(95%CI 0.57~0.67)和0.65(95%CI 0.58~0.72),与Metroticket和HALT-HCC评分相比差异无统计学意义。LITES-HCC评分能够在符合Milan和UCSF的患者中,根据移植后的存活率来区分患者。

总之,David等开发并验证了一种风险评分方法,可预测肝癌患者移植后的存活率。通过纳入HCC相关和非HCC相关变量(如,年龄、慢性肾脏疾病),该评分方法可使移植专业人员根据预测的移植后存活率将待移植的肝癌患者进行优先排序,可用来决定谁可以优先接受移植

点评:在移植器官来源紧缺的情况下,该方法的确可带来一定好处。但根据谁移植后活下来的概率最大来决定谁接受肝移植,这一做法很欧美,一如新冠疫情中,欧美国家不给60岁以上的患者使用呼吸机一样……

原始出处:

Goldberg David,Mantero Alejandro,Newcomb Craig et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma using the LiTES-HCC score. J Hepatol, 2021, 10.1016/j.jhep.2020.12.021

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    2021-01-22 gwc384
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    2021-01-20 留走人康

    肝癌,接下来就要细分了,对于体质好的病人,能否将PD-1类+抗血管新生+放疗等相结合,甚至有必要用TACE进行减负

    0

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