Agustos 2010
Hepatosellüler karsinoma tanisi konan hastalar tani aninda karaciger transplantasyonuna ne kadar uygun?
How suitable are hepatocellular carcinoma patients for liver transplantation at the time of diagnosis?
- Ana Sayfa
- Sayılar
- Agustos 2010
- Hepatosellüler karsinoma tanisi konan hastalar tani aninda karaciger transplantasyonuna ne kadar uygun?...
Özet
Giris ve Amaç: Hepatosellüler karsinom açisindan riskli hastalarda takip yapilmasi erken evrede tani konarak küratif tedavilerin uygulanmasina olanak saglamakta, mortaliteyi azaltmakta ve sag kalimi arttirmaktadir. Amacimiz hastanemizde hepatosellüler karsinoma tanisi konmus hastalarin basvuru anindaki durumlarini belirlemek ve hastalarin ve hekimlerin takip programina yeterince uyup uyulmadigini irdeleyebilmektir. Gereç ve Yöntem: Gastroenteroloji Klinigi?nde 20052009 yillarinda hepatosellüler karsinom tanisi konan veya baska merkezlerde hepatosellüler karsinom tanisi konarak sevk edilen hastalar retrospektif olarak incelendi. Hastalarin demografik bulgulari, siroz gibi risk faktörlerinin varligi, tani anindaki biyokimyasal degerleri ve görüntüleme bulgulari kaydedilerek son durumlari degerlendirildi. Bulgular: Hepatosellüler karsinom tanisi kolan toplam 66 hasta çalismaya alindi. Hastalarin sadece 4 tanesi standard takip programinda iken, geri kalan 13 hasta düzensiz takipte, 38 hasta ise takip altinda degildi. 11 hastada hepatosellüler karsinoma tanisi kondugu tarihe kadar altta yatan hastalik siroz tanisi konmamisti. Ilk basvuru anindaki 66 hastanin 49 tanesi Milan, 40 tanesi University of California San Francisco ve 39 tanesi Clinica Universitaria de Navara kriterlerine göre karaciger transplantasyonuna uygun degildi. Ortalama sagkalim süresi Milan kriterlerini tasimayan grupta 6 ay, University of California San Francisco ve Clinica Universitaria de Navara kriterlerini tasimayan grupta 5,8 aydi. Etiyolojik nedenlerle sagkalim süresi arasinda bir iliski yoktu. Milan kriterlerini tasimayan grupta albumin degeri düsük bulundu. Sonuç: Dis merkezlerden sevk edilen veya ilk olarak bize basvuran hasta grubunda hepatoselüler karsinoma takibinin yapilmadigi ya da yapilanlarin yeterli olmadigi asikardir. Bu yüzden hepatosellüler karsinom tanisi konan hastalar daha ilk tani aninda karaciger transplantasyonu sansini kaybetmektedir.
Abstract
Background and Aims: Surveillance of patients at high risk for hepatocellular carcinoma provides the opportunity for application of curative treatments via detection of earlier disease, thereby facilitating a decrease in mortality and improvement in survival. The aim of this study was to determine the suitability of patients with hepatocellular carcinoma for liver transplantation at the time of their initial presentation and also to evaluate the adherence of physicians and patients to the surveillance program. Materials and Methods: The patients diagnosed with hepatocellular carcinoma in the Gastroenterology Clinic and referred to our clinic with the diagnosis of hepatocellular carcinoma between 2005 and 2009 were retrospectively evaluated. The patients were reviewed for demographic features, presence of risk factors, biochemical test results, and radiological findings. Results: Totally, 66 patients with hepatocellular carcinoma were enrolled in this study. Of them, only 4 patients were under a standard surveillance program for hepatocellular carcinoma, whereas 13 patients were in a substandard surveillance program and 38 patients were in no surveillance program. In 11 patients, the diagnosis of cirrhosis was not made until the diagnosis of hepatocellular carcinoma. The number of patients who were not suitable for liver transplantation at the time of diagnosis according to the Milan, University of California San Francisco and Clinica Universitaria de Navara criteria were 49, 40 and 39, respectively. The mean survival was 6 months in patients who did not meet the Milan criteria, whereas it was 5.8 months in patients who did not meet the University of California San Francisco and Clinica Universitaria de Navara criteria. There was no relationship between etiology and survival. Serum albumin level was lower in patients who did not meet the Milan criteria. Conclusions: It is obvious that the surveillance for hepatocellular carcinoma is not performed adequately and that adherence to surveillance is suboptimal both in our patients and in patients referred to us from other centers. Therefore, most patients with hepatocellular carcinoma miss the opportunity for liver transplantation at the time of their diagnosis.
