符合米兰标准和杭州标准的肝癌肝移植受者预后回顾性分析

Prognosis of patients with hepatocellular carcinoma meeting Milan criteria or Hangzhou criteria of liver transplantation: a retrospective analysis

目的比较符合米兰标准和符合杭州标准的肝细胞肝癌(HCC)患者行肝移植术后生存和肿瘤复发情况,验证杭州标准的临床应用价值。方法回顾性分析2006年1月至2011年12月中国肝移植注册登记的肝移植手术,并在浙江大学医学院附属第一医院、重庆医科大学附属第一医院两家肝移植中心接受随访调查受者的临床资料,196例肝癌肝移植受者纳入研究。将符合米兰标准的HCC患者作为米兰标准组,共90例(45.9%);超出米兰标准但符合杭州标准者作为杭州标准组,共40例(20.4%);肿瘤结节直径之和>8 cm,术前AFP>400 ng/m L且组织学分级为低度分化者作为超出杭州标准组,共66例(33.7%)。比较3组受者术后生存率、无瘤生存率,并评判预后。结果米兰标准组受者术后1、3、5年生存率和1、3、5年无瘤生存率分别为88.9%、73.3%、60.0%和84.4%、66.7%、51.1%,杭州标准组受者术后1、3、5年生存率和1、3、5年无瘤生存率分别为80.0%、65.0%、50.0%和75.0%、55.0%、45.0%,超出杭州标准组受者术后1、3、5年生存率和1、3、5年无瘤生存率分别为57.6%、30.3%、18.1%和45.5%、27.3%、18.1%。对3组受者术后累积生存率和无瘤生存率进行比较,米兰标准组和杭州标准组受者术后1、3、5年生存率和1、3、5年无瘤生存率差异均无统计学意义(P均>0.05),米兰标准组受者术后1、3、5年生存率和无瘤生存率均显著高于超出杭州标准组受者(P均<0.05),杭州标准组受者术后1、3、5年生存率和1、3、5年无瘤生存率均显著高于超出杭州标准组受者(P均<0.05)。结论同米兰标准一样,杭州标准也具有很强的科学性,能够显著拓展受益人群,让更多未符合米兰标准的患者能够施行肝移植术。同时杭州标准能有效预测肝移植受者预后,其创新性提出的生物学标准AFP水平和肿瘤分化程度是影响肝癌肝移植受者术后预后的关键性因素。

Objective In order to validate the application value of Hangzhou criteria,we analyzed survival rates and tumor recurrence rates of patients with hepatocellular carcinoma after liver transplantation and compared whether there were differences between patients meeting Milan criteria and Hangzhou criteria. Methods A retrospective analysis was performed by comparing the survival rates and tumor recurrence rates of 196 patients in two liver transplantation centers of China from January2006 to December 2011. Ninty patients meeting Milan criteria was divided into Milan criteria group.Fourty patients who exceeded Milan criteria but still met Hangzhou criteria were assigned into Hangzhoucriteria group. The remaining 66 patients exceeding Hangzhou criteria（ a maximum tumor diameter of more than 8 cm,with low differentiated,and with a preoperative AFP level of more than 400 ng / m L）were arranged into Hangzhou criteria exceeding group. Results Hangzhou criteria significantly expanded 44. 4% of patients when compared with Milan criteria. 1-,3-and 5-year survival rates and1-,3-and 5-year tumor free survival rates of Milan criteria group were 88. 9%,73. 3%,60. 0% and84. 4%,66. 7%,51. 1%,respectively. While the rates of Hangzhou criteria group were 80. 0%,65. 0%,50. 0% and 75. 0%,55. 0%,45. 0%,respectively. 1-,3-and 5-year survival rates and1-,3- and 5-year tumor free survival rates of Hangzhou criteria exceeding group were 57. 6%,30. 3%,18. 1% and 45. 5%,27. 3%,18. 1%,respectively. There were no significant differences in1-,3-and 5-year survival rates and 1-,3-and 5-year tumor free rates between Milan criteria group and Hangzhou criteria group（ P〉0. 05）. In contrast,there were significant differences between Hangzhou criteria group and Hangzhou criteria exceeding group in 1-,3-and 5-year survival rates and 1-,3-and5-year tumor free survival rates（ P〈0. 05）,so were the Milan criteria group and Hangzhou criteria exceeding group（ P〈0. 05）. Conclusions Hangzhou criteria is scientific as much as Milan criteria.It can bring more patients with hepatocellular carcinoma into meeting the criteria of liver transplantation without affecting the overall survival rate. Accordingly,Hangzhou criteria can effectively predict the prognosis of patients after liver transplantation. Besides,the level of biological indicator AFP and the degree of tumor differentiation innovatively proposed by Hangzhou criteria are proved to be key elements in affecting the prognosis of patients after liver transplantation.