12例胆管细胞癌患者肝移植的预后分析

The outcome of liver transplantation for 12 patients with cholangiocellular carcinoma

目的分析影响胆管细胞癌患者肝移植预后的肿瘤相关因素,为肝移植受者的选择提供依据。方法12例胆管细胞癌患者接受肝移植治疗,肿瘤Edmondson分级为Ⅲ～Ⅳ级者5例;肿瘤TNM分期超过Ⅱ期者9例;肿瘤累及两叶者5例,无包膜者9例,肝门淋巴结肿大者5例,肝外膈肌浸润1例,门静脉分支有癌栓者1例;个体最大肿瘤直径平均为6.1 cm。均行经典原位肝移植。采用Kaplan-Meier生存率分析肝移植术后患者存活率及无瘤存活率,Log-Rank检验各影响因素的组间差异。结果12例术后均得到随访,随访时间7～31.2个月,中位数为18.5个月,受者的存活时间为178～905 d,中位数为370 d,其0.5、1和2年存活率分别为90.9%、61.4%及24.6%,0.5、1和2年无瘤存活率分别为46.9%、37.5%和0。8例(66.7%,8/12)于肝移植后100.6 d肿瘤复发。死亡6例,其中5例死于肿瘤复发。以肝细胞癌施行肝移植的标准(Milan标准、加州大学旧金山分校标准、上海复旦标准者、Pittsburgh标准和超过Pittsburgh标准)来评价,结果符合各标准患者肝移植后的存活率及无瘤存活率的差异均无统计学意义。淋巴结转移或门静脉癌栓、TNM分期为Ⅲ期、Edmondson分级为Ⅲ级、肿瘤累及两叶、肿瘤无包膜及术前糖链抗原19-9≥37 kU/L等,可能对预后有一定影响。结论胆管细胞癌患者施行肝移植的预后不佳,应慎重选择,尽量以小肝癌为主,对肿瘤过大、TNM分期为Ⅲ期、肿瘤分布于两叶、无法排除淋巴结转移或门静脉癌栓者,应列为肝移植禁忌证。

Objective To study the indications and identify the influence of tumor characteristics on the outcome of liver transplantation （LT） among patients with cholangiocellular carcinoma （CCC）. Methods A retrospective analysis was performed on 12 consecutive patients with CCC who underwent LT between April 2001 and November 2006 at our institution （Edmondson Ⅲ-Ⅳ, 5 cases; TNM〉Ⅱ, 9 cases; Bilobe involvement, 5 cases; no capsule, 9 cases; lymph node metastasis, 5 cases; disphragmatic muscle involvement, 1 case; mean of the tumor diameter, 6.1cm）. The outcome of the patients classified by different tumor related factors was compared. Survival analysis was performed using Kaplan-Meier methods. Results The mean fellow-up time was 18. 5 months （7 - 31.2 months）, and the survival time was 370 days （178- 905 days）. The 0. 5-, 1- and 2-year survival rate and disease-free survival rate of all the patients were 90. 9 %, 61.4 %, 24. 6 % and 46. 9 %, 37. 5 %, 0 respectively. The recurrence rate and mortality were 66. 7 % and 50 % respectively. There was no significant difference between different LT indications （P〉0.05）. Lymph node metas-tasis, macroscopic vascular invasion, TNM classification, Edmondson pathologic classification, tumor location and capsule, carbohydrate antigen 19-9 （CA19-9） might affect the outcome post-LT. Conclu- sion The overall survival of LT for CCC was dismal. We should select the recipients very carefully and strictly. Those CCC patients with large tumor, TNM class-Ⅲ, bi-lobe distribution or who can not be ruled out lymph node or vascular invasion, should be contraindicated for LT.