肝癌肝移植的标准及其与预后的关系

Relation of criteria of hepatoceilular carcinoma for liver transplantation to prognosis

目的 评价肝移植治疗肝细胞癌的价值以及受者选择对病人术后存活的影响.方法 对我院2000年6月至2007年2月实施的63例原发性肝细胞癌肝移植临床资料进行回顾性分析.采用kaplan-meier法进行生存率统计分析.结果 63例原发性肝细胞癌病人肝移植术后1、3、5年累积生存率分别为77.4%、59.3%、48.9%.符合Milan标准、符合UCSF标准和不符合UCSF标准受者,肝移植术后1、3、5年累积生存率分别为93.8%、92.1%、29.2%;80.8%、79.2%、8.3%;80.8%、79.2%、0.符合Milan标准、符合UCSF标准和不符合UCSF标准受者,术后1、2、3年肿瘤累积复发率分别为6.2%、15.5%、19.2%;7.9%、15.9%、20.8%;70.8%、87.5%、91.7%（P＜0.01）.但是,符合UCSF标准与符合Milan标准受者移植术后累积生存率和肝癌累积复发率相似（P＞0.05）.结论 以UCSF标准筛选肝癌病人进行肝移植不仅扩大了肝癌肝移植的适应证,还可以取得与Milan标准同样的效果.

Objective To assess the efficacy of orthotopic liver transplantation （OLT） for hepatocellular carcinoma （HCC） and the effect of recipient selection on postoperative survival. Methods The clinical data of 63 patients with primary HCC receiving OLT in this hospital from June 2000 to February 2007 were retrospectively analyzed. The cumulative survival rate after transplantation was analyzed by the Kaplan-Meier method. Results The 1-, 3- and 5-year cumulative survival rates of the 63 patients were 77.4%, 59.3%, 48. 9%, respectively. The rates in conformation with Milan criteria, UCSF criteria and beyond UCSF criteria were 93.8%, 80.8%, 80.8%; 92.1%, 79.2%,79.2%; 29.2%, 8.3%, 0, respectively. The 1-, 3-, 5-year cumulative recurrent rate of patients meeting Milan criteria, UCSF criteria and beyond UCSF criteria was 6.2%, 15.5%, 19. 2%; 7. 9%,15.9%, 20. 8% ; 70. 8%, 87. 5%, 91.7%, respectively （P〈0.01）. However, tumor recurrence and survival rates were similar for patients meeting UCSF and Milan criteria （P〉0. 05）. Conclusion Expansion of OLT criteria is justified for HCC and does not adversely impact the posttransplant prognosis by the UCSF criteria as compared with the Milan criteria.