肝癌患者的肝脏移植新标准出台
文章来源:未知 文章作者:meng 发布时间:2010-07-29 03:03 字体: [ ]  进入论坛
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Researchers at the University of California, San Francisco propose that treatments used on liver cancers beyond the established Milan criteria1 for liver transplantation may be appropriate for all patients with hepatocellular carcinoma (HCC肝细胞癌) who are listed for transplantation. Full details appear in the August issue of Liver Transplantation, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases (AASLD). According to the American Cancer Society, about 90% of adult primary liver cancers are hepatocellular carcinomas. In 2009, an estimated 22,620 adults in the U.S. were diagnosed with primary liver cancer with 18,160 deaths expected to occur this year from HCC. Liver cancer is the sixth most common cause of cancer death among men, and ninth most common cause of cancer death among women.

Liver transplantation is an important treatment option for selected patients with non-resectable(可切除的) HCC. The Milan criteria provide guidelines to qualify HCC patients for liver transplantation and include one tumor2 smaller than 5 cm or up to 3 tumors smaller than 3 cm, no extrahepatic(肝外的) manifestations3(临床表现,显示) , and no vascular4(血管的) invasion. The Milan criteria were adopted because it identified a population with excellent outcome potential following transplantation—roughly equivalent to patients transplanted without HCC. However, HCC incidence is expected to increase and researchers are investigating whether the criteria for liver transplantation should be expanded to make even more patients eligible5.

The San Francisco researchers suggest that the Milan and other criteria have proved inadequate6. Team leader Dr. John Roberts explains, "It has not been shown there is any particular size of tumor that represents a 'no risk' of recurrence8, at least among those tumors that can be detected radiologically. Further, the degree of risk is not the same for all patients within the Milan criteria."

Dr. Roberts points out that tumor size and number are only surrogate(代理,代用品) markers for underlying9 tumor biology and that using another marker—tumor behavior over time—allows the biology of the tumor to become apparent, dictating10 the most appropriate treatment strategy.

The UCSF team has taken a 'down staging' approach for patients with large tumors. This involves radiofrequency ablation(消融,切除) , chemoembolization(化学栓塞治疗) or both to control the tumor and then a requisite11(必备的,需要的) waiting period to determine tumor biology over time as the development of extra-hepatic or intra-hepatic spread is observed. This paradigm12 results in about 30% of the patients being ineligible13 for transplantation because of HCC progression, but those who make it to transplantation have an excellent outcome as compared to patients transplanted with tumors beyond the Milan criteria who are not treated. The median time between the first ablative(消融的) procedure and transplantation was 8.2 months with a range of 3-25 months. This approach suggests that the test of time may be the surest method to select patients with HCC who are destined14 to have good transplant outcomes. Dr. Roberts argues that this approach, ablating the tumor and waiting, should be expanded to all patients listed for transplantation with hepatocellular carcinoma as the test of time can eliminate from transplantation patients whose disease is likely to recur7 after transplantation.

"Our experience with ablative treatment and then observation suggests that the ultimate outcomes of transplantation are not dependent on the primary tumor but more on time spent waiting for transplantation," Dr. Roberts concluded. "It would seem logical that smaller and/or fewer tumors, though more unlikely to have spread, would also benefit from a period of time if the primary tumor can be controlled. The waiting period may be able to decrease the 10% recurrence rate seen in patients transplanted within Milan."



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1 criteria vafyC     
n.标准
参考例句:
  • The main criterion is value for money.主要的标准是钱要用得划算。
  • There are strict criteria for inclusion in the competition.参赛的标准很严格。
2 tumor fKxzm     
n.(肿)瘤,肿块(英)tumour
参考例句:
  • He was died of a malignant tumor.他死于恶性肿瘤。
  • The surgeons irradiated the tumor.外科医生用X射线照射那个肿瘤。
3 manifestations 630b7ac2a729f8638c572ec034f8688f     
n.表示,显示(manifestation的复数形式)
参考例句:
  • These were manifestations of the darker side of his character. 这些是他性格阴暗面的表现。 来自《简明英汉词典》
  • To be wordly-wise and play safe is one of the manifestations of liberalism. 明哲保身是自由主义的表现之一。 来自《现代汉英综合大词典》
4 vascular cidw6     
adj.血管的,脉管的
参考例句:
  • The mechanism of this anomalous vascular response is unknown.此种不规则的血管反应的机制尚不清楚。
  • The vascular changes interfere with diffusion of nutrients from plasma into adjacent perivascular tissue and cells.这些血管变化干扰了营养物质从血浆中向血管周围邻接的组织和细胞扩散。
5 eligible Cq6xL     
adj.有条件被选中的;(尤指婚姻等)合适(意)的
参考例句:
  • He is an eligible young man.他是一个合格的年轻人。
  • Helen married an eligible bachelor.海伦嫁给了一个中意的单身汉。
6 inadequate 2kzyk     
adj.(for,to)不充足的,不适当的
参考例句:
  • The supply is inadequate to meet the demand.供不应求。
  • She was inadequate to the demands that were made on her.她还无力满足对她提出的各项要求。
7 recur wCqyG     
vi.复发,重现,再发生
参考例句:
  • Economic crises recur periodically.经济危机周期性地发生。
  • Of course,many problems recur at various periods.当然,有许多问题会在不同的时期反复提出。
8 recurrence ckazKP     
n.复发,反复,重现
参考例句:
  • More care in the future will prevent recurrence of the mistake.将来的小心可防止错误的重现。
  • He was aware of the possibility of a recurrence of his illness.他知道他的病有可能复发。
9 underlying 5fyz8c     
adj.在下面的,含蓄的,潜在的
参考例句:
  • The underlying theme of the novel is very serious.小说隐含的主题是十分严肃的。
  • This word has its underlying meaning.这个单词有它潜在的含义。
10 dictating 9b59a64fc77acba89b2fa4a927b010fe     
v.大声讲或读( dictate的现在分词 );口授;支配;摆布
参考例句:
  • The manager was dictating a letter to the secretary. 经理在向秘书口授信稿。 来自辞典例句
  • Her face is impassive as she listens to Miller dictating the warrant for her arrest. 她毫无表情地在听米勒口述拘留她的证书。 来自辞典例句
11 requisite 2W0xu     
adj.需要的,必不可少的;n.必需品
参考例句:
  • He hasn't got the requisite qualifications for the job.他不具备这工作所需的资格。
  • Food and air are requisite for life.食物和空气是生命的必需品。
12 paradigm c48zJ     
n.例子,模范,词形变化表
参考例句:
  • He had become the paradigm of the successful man. 他已经成为成功人士的典范。
  • Moreover,the results of this research can be the new learning paradigm for digital design studios.除此之外,本研究的研究成果也可以为数位设计课程建立一个新的学习范例。
13 ineligible o7Ixj     
adj.无资格的,不适当的
参考例句:
  • The new rules have made thousands more people ineligible for legal aid.新规定使另外数千人不符合接受法律援助的资格。
  • The country had been declared ineligible for World Bank lending.这个国家已被宣布没有资格获得世界银行的贷款。
14 destined Dunznz     
adj.命中注定的;(for)以…为目的地的
参考例句:
  • It was destined that they would marry.他们结婚是缘分。
  • The shipment is destined for America.这批货物将运往美国。
TAG标签: patients cancer liver
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