 肝臟移植治療肝癌的最新發展 | |
| 主辦單位 | 社團法人高雄縣醫師公會 |
| 協辦單位 | 高雄市立鳳山醫院（委託財團法人長庚紀念醫院經營） |
| 上課日期時間 | 111年10月11日（星期二）12:30~14:30 |
| 課程地點 | 會議網址：https://cgmh.webex.com/cgmh/j.php?MTID=m052ed5d1846afe638d8ff467d36ac5d1 會議室ID：25109428033 會議密碼：mPOUX1D4： |
| 報名截止日期 | 視訊課程免報名 |
| 講師 | 林志哲／長庚醫療財團法人高雄長庚紀念醫院外科 |
| 課程大綱 | Liver transplantation (LT) for hepatocellular carcinoma (HCC) at Kaohsiung Chang Gung Memorial Hospital manly relies on live donor LT (LDLT). Owing to taking the risk of live donor, we are obligated to adopt strict selection criteria for HCC patients and optimize the pre-transplant conditions to ensure a high disease-free survival similar to those without HCC, even better than deceased donor (DDLT). Better outcomes are attributed to excellent surgical results and optimal patient selection. Primary LDLT (no history of previous liver resection for HCC)does not only resect the tumor but also cure the underlying liver cirrhosis and hepatitis. Primary LDLT provides the best long-term survival for HCC within UCSF criteria; achieving over 85% of 5-year survival rate. Salvage LDLT also emerges the best results for recurrence HCC after curative resection, compared with local regional therapy or re-resection. Although salvage LDLT carries higher incidence of surgical complication, the hospital mortality is similar to primary LDLT. The surgical mortality including primary and salvage LDLT has been <3% in the past two decades of over 2000 cases. Although Taiwan Health Insurance Policy extended the Milan to UCSF criteria in 2006, selection criteria will not be consolidated to take into account only by the morphologic size/number of tumors but also by their biology. The criteria are divided into modifiable image morphology, alpha fetoprotein (AFP), and PET scan with SUV and unmodifiable unfavorable pathology such as tumors combined with cholangiocarcinoma, sarcomatoid type, poorly differentiation. Downstaging therapy is necessary for HCC patients beyond criteria to fit all modifiable standards such tumor size, number and high AFP. The upper limit of downstaging treatment seems to be extended by more effective drug eluding transarterial chemoembolization in cases without absolute contraindications. In contrast, the pitfall of unmodifiable tumor pathology should be excluded by the findings of pre-transplant core biopsy/resection, such as HCC combined cholangiocarcinoma, poor differentiation and sarcomatid type HCC. We found that pre-transplant, non invasive PET scan is a useful modality to predict unfavorable pathology (sensitivity: 75%, specificity: 75%, NPV: 92.3%, and accuracy: 75%) by using the cuff of tumor to nontumor ratio (TNR) ≥ 2 before transplant. PET scan has therefore been becoming the mandatory pre-transplant screening in our algorithm. More recently, complete tumor necrosis in explanted liver predicts almost no recurrence after transplant. Necrotizing therapy is advised if possible before transplant even the tumor status within criteria to minimize the possibility of tumor recurrence. For high risk of HCC after curative hepatectomy, pre-emptive sequential LDLT approach might be associated with low incidence of cancer recurrence, better overall survival, and less operative mortality. LDLT with low surgical mortality in experienced centers provides the opportunities of optimizing the pre-transplant tumor conditions and timing of transplant to achieve better outcomes. In the future, radiotherapy by proton or Ye-trim-90 TARE , immunotherapy and target therapy could be applied to downstaging procedure, attempting to alter tumor behavior. Postoperative adjuvant therapy by using new generation target therapy has been tried to reduce the recurrence for high risk patients. The short-term results are promising and wait for long-term survival outcomes. Taking together, LDLT combined with other modalites have been increasing long-term overall survival for ever incurable HCC. |
| 積分 | 西醫師繼續教育積分、家醫科 |