肝癌肝移植预后相关因素分析

Influence of tumor characteristics on the outcome of liver transplantation among patients with hepatocellular carcinoma

目的分析对预后有显著影响的肿瘤相关因素,为肝癌肝移植适应证的选择提供依据。方法回顾性分析我院2001年4月至2006年2月间251例肝细胞癌肝移植病例,Kaplan-Meier生存率统计分析各种肿瘤相关性因素对肝癌肝移植术后生存率及无瘤生存率的影响,Log Rank 检验组间差异,COX 多因素回归分析对预后有显著影响的危险因素。结果对术后生存率和/或无瘤生存率有显著影响的因素有:大血管癌栓、淋巴结转移、Edmondson 分级、镜下癌栓、肿瘤部位、播散灶、术前甲胎蛋白(AFP)等(P<0.05或 P<0.01);而术前治疗史及肝炎背景对术后生存率及无瘤生存率差异均无统计学意义(P>0.05)。Cox 多因素分析对生存率或无瘤生存率有显著影响的指标有:大血管癌栓、肿瘤播散灶及镜下癌栓(P<0.05或 P<0.01)。结论 Edmondson 分级Ⅲ～Ⅳ级、镜下癌栓、肿瘤位于左叶或两叶、肿瘤有播散灶及术前 AFP≥300μg/L 等都是肝癌肝移植危险因素,提示预后不良。有大血管癌栓、淋巴结转移的预后极差,应列为肝癌肝移植禁忌证。

Objective To identify the influence of tumor characteristics on the outcome of liver transplantation （LT） among patients with hepatocellular carcinoma （HCC）. Methods A retrospective analysis was performed on 251 consecutive patients with HCC who underwent LT between April 2001 and February 2006 at our institution. We compared the outcome of the patients classified by different tumor related factors. Survival analysis was performed using Kaplan-Meier and Cox proportional hazards regression methods. Results Macroscopic vascular invasion, lymph node metastasis, Edmondson pathologic classification, microscopic tumor thrombosis, tumor location, satellite nodules and α-fetal protein （AFP） all significantly affected the overall survival and/or recurrence-free survival post-LT （ P 〈0. 01 or P 〈 0. 05 ）. Pre-operative treatment and hepatitis background had no effect to the prognosis （P 〉 0. 05）. At multivariate Cox regression analysis, the factors associated with mortality or recurrence were macroscopic vascular invasion, microscopic tumor thrombosis and satellite nodules （ P 〈 0. 01 or P 〈 0.05 ） . Conclusion Edmondson grade Ⅲ-Ⅳ, microscopic tumor thrombosis, left lobar or bilobar tumor, satellite nodules and AFP≥300 μg/L were predictive factors of poor prognosis. Presence of macroscopic vascular invasion or lymph node metastasis should be contraindicated.