影响肝细胞癌患者肝移植后肿瘤复发及预后的相关因素

Relationship between clinicopathologic features and neoplasm recurrence,prognosis in hepatocellular carcinoma after liver transplantation

目的分析影响肝细胞癌(HCC)患者肝移植后肿瘤复发和预后的相关因素,总结HCC患者肝移植的选择标准。方法回顾性分析118例HCC肝移植受者的临床资料,应用单因素和多因素的分析方法,分析临床和病理等相关因素对HCC患者肝移植后肿瘤复发及预后的影响,筛选出影响肿瘤复发和预后的危险因素,并结合国际HCC肝移植受者选择标准运用于临床。结果HCC患者肝移植围手术期死亡8例,对存活的110例随访1～32个月,其中有41例肿瘤复发(37.3 %),死亡39例(35.5%);12、18和24个月的累积存活率分别是84.55%、70.30%和62.24%;12、18和24个月的无瘤存活率分别是69.05%、66.93%和61.38%。单因素分析结果显示癌栓形成、米兰标准、肿瘤大小、肿瘤分化程度以及pTNM分期对HCC患者肝移植后肿瘤复发有显著影响;癌栓形成、米兰标准、术前血清甲胎蛋白(AFP)水平、肿瘤分化程度以及pTNM分期对患者预后有显著影响;多因素分析显示,癌栓形成和肿瘤分化程度是肿瘤复发的独立影响因素,癌栓形成和术前AFP水平则是影响预后的独立危险因素。结论癌栓形成和肿瘤分化程度是影响HCC患者肝移植后肿瘤复发的独立因素,而癌栓形成和术前AFP水平是影响预后的独立危险因素。

Objective To study the risk factors affecting neoplasm recurrence and survival of hepatocellular carcinoma （HCC） following liver transplantation （LT）. Methods The clinicopatholo gic data, neoplasm recurrence and survival results of 118 patients with HCC receiving LT were retrospectively analyzed and various clinicopathologic risk factors for neoplasm recurrence and survival were evaluated by univariate and multivariate analysis. Results The follow-up time ranged from 1 to 32 months. The recurrence rate was 37. 3% and the mortality was 35.5 %. The 12-, 18-, 24-month survival rate was 84. 55%, 70. 30 % and 62. 24 %, respectively. The 12-, 18-, 24-month neoplasm free survival rate was 69. 05 %, 66. 93 % and 61.38 %, respectively. In the univariate analysis, por tal vein neoplasm thrombus （PVTT）, Milan-criteria, neoplasm size, histological differentiation and pTNM stage were associated significantly with neoplasm recurrence, and PVTT, Milan-criteria, pre operative alpha-fetoprotein （AFP）, histological differentiation and pTNM stage were associated signif- icantly with survival rate; In the multivariate Logistic regression analysis, PVTT and histological dif- ferentiation were independent predictive factors of neoplasm recurrence, and multivariate Cox regression analysis showed that PVTT and AFP independently associated with prognosis. Conclusions PVTT and histological differentiation are the most important predictive factors of neoplasm recurrence, and PVTT and AFP independently predict the survival of patients undergoing LT.