肝癌肝移植受者一年内致死性复发风险因素分析

Risk factors attributing to fatal recurrence in liver transplant recipients with hepatocellular carcinoma died within one year

目的分析影响肝细胞癌肝移植术后一年内因转移复发死亡的临床病理学风险因素。方法回顾性分析2002年4月至2005年4月间武警总医院器官移植研究所303例肝细胞肝癌行肝移植病人一年内因转移复发而死亡受者（致死性复发组）的临床病理资料，与未复发或复发但未在一年内死亡的受者（对照组）比较，采用logistic回归分析探讨临床病理学风险因素对一年生存率的影响。结果303例病人中有48例在一年内因转移复发死亡（死亡率15．84％），多因素分析显示肿瘤血管浸润、直径≥6．5cm和移植术前血清AFP≥1000μg／L是致死性复发的独立风险因素。同时具备上述三种风险因素受者一年内致死性复发85．71％，同时具有2项以上风险者37．84％，具备其中一项风险因素者13．64％，不具备三种中任何一种风险因素者致死性复发发生率为6．71％。结论三种导致肝细胞肝癌病人在手术后一年内因肿瘤复发转移死亡的主要危险因素是肿瘤血管浸润、直径≥6．5cm和移植术前血清AFP≥1000μg／L。同时具备2个或2个以上的致死性复发的临床病理学风险病人不适宜作为肝移植的适应证。

Objective To investigate the clinicopathological risk factors for fatal recurrence of hepatocellular carcinoma （HCC） in orthotopic liver transplant （OLT） recipients died within one year. Methods The clinical data of 303 patients receiving OLT in our hospital from April 2002 to April 2005 were retrospectively analyzed. Forty-eight of these patients who demonstrated diffuse intra-hepatic or multiple systemic recurrent lesions and died within 1 year after surgery were furthere investigated. The remaining patients were designated as the control group. The 2 groups were compared for clinicopathologic risk factors by logistic regression analysis. Results Among the 303 patients, 48 were enrolled in the fatal recurrence group （15.84%）. Multivariate analysis showed that presence of vascular invasion, tumor size greater than 6.5 cm, and pre-operative serum alpha-fetoprotein （AFP） level greater than 1000 μg/L were the risk factors in the fatal recurrence group. A percentage of 85.71 % of the patients who had all the three risk factors, 37.84% of those who had two risk factors, 13.64% of those who had one risk factors, and 6.71% of those who had none risk factors died because of recurrence within 1 year after transplantation. Conclusion Three distinct risk factors attributing to fatal recurrence of liver transplant recipients for HCC are vascular invasion, tumor size ≥6.5 cm, and preoperative serum AFP level ≥1000 μg/L. The high risk HCC patients with two or more risk factors should not be the candidates for liver transplantation.