影响肝癌肝移植术后肿瘤复发转移的临床病理因素

Clinical and Pathological Factors Associated with Recurrence and Metastasis of Hepatocellular Carcinoma after Liver Transplantation

目的:探讨肝细胞癌患者肝移植术后肿瘤复发转移的临床和病理因素。方法:回顾性分析2002年1月～2006年6月期间施行的781例以肝细胞癌行首次肝移植患者术后的无瘤生存情况,应用单因素分析和Cox回归多因素分析各项临床及病理指标对肿瘤复发转移的影响。结果:移植术后6个月、1、2、3年的无瘤生存率分别为86.85%、74.87%、63.36%和56.67%。术后肝癌复发或转移后1年生存率为26.27%。Cox回归多因素分析发现,影响术后肝癌复发转移的独立危险因素包括肿瘤最大直径、数目、双叶分布、血管侵犯和术前甲胎蛋白。研究发现,存在肉眼癌栓的患者术后HCC复发转移的风险是无癌栓患者的9倍,存在镜下微血管侵犯的患者复发转移风险可达5倍。结论:严格筛选肝癌肝移植的适应证可以有效降低肿瘤复发转移的风险。

Objective： To explore the clinical and pathological factors associated with hepatocellular carcinoma （HCC） recurrence and metastasis after liver transplantation. Methods： The clinical records and tumor-free survival data of 781 patients with HCC who underwent primary liver transplantation from January 2002 to June 2006 were retrospectively analyzed. Clinical and pathological risk factors associated with HCC recurrence and metastasis were evaluated by univariate and Cox multivariate analysis. Results： The 6-month, 1-, 2- and 3-year tumor-free survival rates were 86.85%, 74.87%, 63.36%, and 56.67%, respectively. After recurrence or metastasis of HCC, the 1-year survival rate was 26.27%. Multivariate analysis using Cox proportional hazards regression model demonstrated the diameter of the largest tumor, tumor number, bilobular distribution, vascular invasion and pretransplant alpha fetal protein level to be independent factors associated with recurrence or metastasis of HCC. Conclusion： Strict selection of recipients can effectively prevent the recurrence and metastasis of HCC.