肝癌肝移植预后的多因素相关分析

A Multivariate Analysis of 204 Patients with Hepatocellular Carcinoma after Liver Transplantation

目的：评估肝细胞癌（hepatocellular carcinoma，HCC）临床病理特征和受体选择标准对肝移植预后的影响。方法：回顾性分析204例肝细胞癌行肝移植受者的临床资料，寿命表法计算生存率，Kaplan—Meier法绘制术后累计生存率曲线，Log—rankx。检验行生存曲线之间的比较，COX比例风险回归模型进行单因素和多因素分析。结果：全组随访时间6～62个月，中位时间40．9个月，随访期间死亡90例（33．1％），肿瘤复发88例（32．4％），复发中位时间8．5个月（2—26个月）。1年、2年、3年、4年、5年生存率分别为82．2±2．5％、65．0±3．3％、52.3±4．0％、46．9±4．6％和42．0±6．2％。单因素分析提示影响HCC预后的临床及病理因素包括甲胎蛋白、肿瘤大小、侵犯包膜、Eggels分类、微血管侵犯、门静脉左右分支侵犯、Edmonson分级、TNM分期和MELD，多因素分析发现甲胎蛋白（RR：1．542，P=0．002）、Eggels分类（RR：1．617，P=0．003）、微血管浸润（RR：2．643，19〈0．001）和Edmonson分级（RR：2．181，P=-0．009）是独立影响HCC预后的重要因素；符合Milan标准和UCSF标准累积生存率明显高于超出标准者（P均〈0．001）。结论：甲胎蛋白、Eggels分类、微血管浸润和Edmonson分级是独立影响HCC预后的因素；经严格筛选的适宜受体预后良好。

Objective： To evaluate the prognostic value of histopathologic factors and criteria for recipient selection in patients with hepatocellular carcinoma after liver transplantation （LT）. Methods： A retrospective study was carried out in 204 HCC patients after liver transplantation. Survival rates were analyzed with the actuarial life-table method. Multivariate and univariate Cox proportional hazards model were used to investigate the correlation between histopathologic factors and survival time. Kaplan-Meier and Log-rank tests were used to explore the correlation between survival rates and histopathologic factors. Results： The follow-up duration ranged from 6 to 62 months. The mortality was 33.1%. The recurrence rate was 32.4%. The 1-, 2-, 3-, 4- and 5-year cumulative survival rates were 82.2%, 65.0%, 52.3%, 46.9%, and 42.0%, respectively. Through a COX model analysis, univariate analyses revealed that alpha fetoprotein, tumor size, envelope invasion, Eggels classification, microvascular invasion, invasion of portal vein, Edmonson grade, TNM staging and scores of Model of end stage liver disease （MELD） were significantly related with survival （P〈0.05）. In a multivariate COX model, alpha fetoprotein （RR： 1.542, P=- 0.002）, Eggels classification （RR： 1.617, P=0.003）, microvascular invasion （RR： 2.643, P〈0.001）and Edmonson grade （RR： 2.181, P=0.009） were independent prognostic factors. Conclusion： Alpha fetoprotein, Eggels classification, microvascular invasion and Edmonson grade were important prognostic factors. A strict selection of recipients is benefitial for long term survival after transplantation.