肝癌肝移植疗效评价及预后多因素分析

Therapeutic effects evaluation of liver transplantation for hepatic carcinoma and multi-factors analysis of theprognosis

目的评价肝移植治疗原发性肝癌的疗效,并分析影响预后的因素。方法回顾性分析2001年12月至2006年12月第二军医大学附属长征医院肝移植科234例肝癌肝移植病人的临床资料。用SPSS11.0软件进行统计分析,用Kaplan-Meier法计算累计和无瘤存活率,Log-rank检验和Cox回归模型分别进行预后单、多因素分析。结果全组随访1～56个月,随访期间死亡85例(36.3%),复发70例(29.9%)。术后6个月及1、2、3、4年累计存活率分别为88.5%及76.3%、61.3%、53.6%、47.6%;6个月及1、2、3年无瘤存活率分别为80.1%及70.6%、60.4%、52.3%。单因素分析显示:术前肝功能Child-Pugh分级、术前甲胎蛋白(AFP)水平、肿瘤类型、肿瘤大小、淋巴结转移、大血管侵犯、肿瘤分化程度和TNM分期与预后有关;Cox回归多因素分析显示:术前AFP水平、肿瘤类型、大血管侵犯和肿瘤分化程度是影响预后的独立因素。结论肝移植是治疗原发性肝癌的有效方法,经严格筛选的适宜受体预后良好。

Objective To evaluate the therapeutic effects of liver transplantation （LT） for primary hepatic carcinoma （PHC） and analyze the prognostic factors. Methods The clinical data of 234 patients underwent LT for hepatic carcinoma admitted between December 2001 and December 2006 at the Department of Liver Transplantation of the Second Affiliated Hospital of the Second Military Medical University were analyzed retrospectively. SPSS11.0 software was used for statistical analysis. The Kaplan-Meier method was used to evaluate the survival rates. Log-rank test and Cox regression model were used to analysis the single and multi-factors for the prognosis respectively. Results The follow-up time ranged from 1 to 56 months. The mortality was 36.3%. The recurrence rate was 29.9%. The 6-month, 1-, 2-, 3-and 4-year patient cumulative survival rates were 88.5%, 76.3%, 61.3%, 53.6% and 47.6%, respectively. The 6-month, 1, 2 and 3-year tumor-free survival rates were 80.1%, 70.6%, 60.4% and 52.3%, respectively, Univariate analysis showed that preoperative Child-pugh grade, serum AFP level, tumor type, tumor size, lymph node metastasis, macrovascular invasive, histological differentiation and TNM stage were prognostic factors of PHC after LT. Multivariate Cox regression analysis showed that the serum AFP level, tumor type, macrovaseular invasive and histological differentiation were independent prognostic factors of PHC. Conclusion Liver transplantation is an effective treatment for PHC patients. Strict selection of recipients benefits long term posttransplant survival.