肝细胞癌肝移植术后复发和转移的研究：单中心经验

Recurrence and metastasis of hepatocellular carcinoma after liver transplantation： single center experiences

目的研究肝细胞癌肝移植术后复发和转移的临床特点及治疗方法。方法回顾分析2003年1月至2005年11月收治的95例肝细胞癌肝移植术后肝癌复发转移病例的临床资料。结果在随访期内，42例（43．2％）患者被诊断为肝癌复发。复发部位最多见于移植肝（32例）、肺（21例）、骨（7例）。单因素分析结果显示，肿瘤大小、肿瘤分布、肝硬化背景、术前甲胎蛋白浓度、组织学分期、大血管侵犯6项因素对肝移植术后生存和（或）肝癌复发有明显影响。多因素分析结果显示，肿瘤分布、组织学分期、大血管侵犯是影响术后总体生存率和肝癌复发率的独立危险因素。肝癌复发后的介入治疗及内放疗可延缓肿瘤进展，选择合适病例行复发灶手术切除可最大限度地改善预后。结论合理选择接受肝移植的肝癌患者可能可以大幅度降低移植术后肝癌的复发率。在现阶段，外科治疗应是目前移植术后复发性肝癌的首选治疗手段。

Objective To study the clinical features and treatment of recurrent hepatocellular carcinoma after liver transplantation. Methods Clinical data of 95 patients with recurrent hepatocellular carcinoma （HCC） after liver transplantation from January 2003 to November 2005 were analyzed retrospectively. Results During follow-up, 42 patients （ 43.2% ） were diagnosed HCC recurrence. The predominant sites of recurrence were liver graft （ 32 cases ）, lung （ 21 cases ） , bone （ 7 cases ）. Tumor size, tumor distribution, liver cirrhosis, pre-transplant AFP level, tumor differentiation, macrovascular invasion were considered risk factors of both post-transplant survival and HCC recurrence in univariate analysis. Tumor distribution, tumor differentiation, macrovascular invasion were considered independent risk factors of both overall post-transplant survival and HCC recurrence in multivariate analysis. Intervention therapy and internal radiation of recurrent HCC could delay tumor progression and resection of recurrent HCC in selected patients can significantly prolong post-recurrence survival. Conclusions Carefully selection of HCC patients as candidates for liver transplantation can significantly reduce HCC recurrence. At the present stage, surgical resection of recurrent HCC is the best treatment method in selected patients.