Liver transplantation for primary and secondary liver tumors: Patient-level meta-analyses compared to UNOS conventional indications.

approach_and_results

We conducted 4 systematic reviews of all series on TO indications (intrahepatic cholangiocarcinoma and perihilar cholangiocarcinoma [phCC]) and liver metastases from neuroendocrine tumors (NETs) and colorectal cancer (CRLM) and compared them using patient-level meta-analyses to data obtained from the United Network for Organ Sharing (UNOS) database considering conventional daily-practice indications.

我们进行了4项系统综述，回顾了所有关于TO适应症（肝内胆管癌和肝门部胆管癌[phCC]）以及神经内分泌肿瘤（NETs）和结直肠癌（CRLM）肝转移的系列研究，并通过患者级别的荟萃分析，将其与从联合器官分享网络（UNOS）数据库获得的数据进行了比较，这些数据考虑了常规的日常实践适应症。

Secondary analyses were done for specific selection criteria (Mayo-like protocols for phCC, SECA-2 for CRLM, and Milan criteria for NET).

对特定选择标准进行了次要分析（对于phCC采用类似Mayo的方案，对于CRLM采用SECA-2方案，对于NET采用米兰标准）。

A total of 112,014 LT were analyzed from 2005 to 2020 from the UNOS databases and compared with 345, 721, 494, and 103 patients obtained from meta-analyses on intrahepatic cholangiocarcinoma and phCC, and liver metastases from NET and CRLM, respectively.

从2005年到2020年，分析了来自UNOS数据库的112,014例肝脏移植（LT），并与来自关于肝内胆管癌和phCC以及NET和CRLM肝转移的荟萃分析的345、721、494和103名患者进行了比较。

Five-year overall survivalwas 53.3%, 56.4%, 68.6%, and 53.8%, respectively.

五年总生存率分别为53.3%，56.4%，68.6%和53.8%。

In Mantel-Cox one-to-one comparisons, survival of TO indications was superior to combined LT, second, and third LT and not statistically significantly different from LT in recipients >70 years and high BMI.

在Mantel-Cox一对一比较中，TO适应症的生存率优于联合LT，第二次和第三次LT，并且与70岁以上和高BMI的LT接受者在统计学上没有显著差异。

Conclusions

Liver transplantation for TO indications has adequate 5-year survival rates, mostly when performed under the selection criteria available in the literature (Mayo-like protocols for phCC, SECA-2 for CRLM, and Milan for NET).

对于TO指征的肝移植，当按照文献中可用的选择标准进行时（如针对phCC的Mayo样方案、针对CRLM的SECA-2方案和针对NET的米兰方案），5年生存率是足够的。

Despite concerns about its impact on the waiting list, some other LT indications are being performed with lower survival rates.

尽管对其对等待名单影响的担忧，一些其他肝移植指征的手术正在以较低的生存率进行。

These oncological patients should be given the opportunity to have a definitive curative therapy within validated criteria.

应当给予这些肿瘤患者在经过验证的标准内接受明确的治愈性治疗的机会。