肝癌肝移植术后复发的危险因素分析

Analysis of Risk Factors for Recurrence of Hepatocellular Carcinoma after Liver Transplantation

目的探讨原发性肝癌(HCC)肝移植术后肿瘤复发或转移的危险因素。方法回顾性我院2003年4月至2007年11月期间76例HCC患者行肝移植的临床资料,根据随访期间是否有复发分为复发组(n=23)和未复发组(n=53),总结肿瘤复发的特点。结果 76例患者中23例(30.3%)术后复发。单因素分析显示患者性别(P=0.449)、年龄(P=0.091)、术前是否治疗(P=0.958)、肿瘤数目(P=0.212)和是否伴有HBV/HCV感染(P=0.220)与肿瘤的复发无关,而肿瘤包膜完整性(P=0.009)、肿瘤分期(P=0.002)、肿瘤直径(P<0.001)、血管侵犯(P<0.001)以及术前AFP水平(P=0.044)与肿瘤的复发有关,其中肿瘤直径<5.0 cm(P=0.001)和术后2个月AFP水平恢复正常者(P<0.001)1年复发率更低。多因素分析显示肿瘤直径(P=0.001,OR=6.456,95%CI为2.356～17.680)、血管侵犯(P=0.030,OR=10.653,95%CI为1.248～90.910)以及术前AFP水平(P=0.017,OR=2.601,95%CI为2.196～5.658)是肝移植术后肿瘤复发的独立危险因素。结论对于肿瘤直径>5.0 cm、伴有血管侵犯以及术前AFP水平≥400μg/L尤其术后2个月AFP水平仍高于正常者术后需加强监测,必要时尽早给予抗肿瘤治疗。

Objective To determine the risk factors for recurrence of hepatocellular carcinoma（HCC） after orthotopic liver transplantation（OLT）.Methods The clinical data from seventy-six consecutive HCC patients who underwent OLT were retrospectively analyzed.The patients were divided into non-recurrence group（n=53） and recurrence group（n=23） based on recurrence,and the characteristics of tumor recurrence were analyzed.Results The overall recurrence rate of tumor was 30.3%（23/76）.By univariate analysis,gender（P=0.449）,age（P=0.091）,received preoperative therapy or not（P=0.958）,tumor numbers（P=0.212）,and HBV/HCV infection（P=0.220） were not closely related with tumor recurrence,while the integrality of tumor capsule（P=0.009）,tumor stage（P=0.002）,tumor diameter（P0.001）,vascular invasion（P0.001）,and AFP level before transplantation（P=0.044） were significantly related with tumor recurrence.Furthermore,the one-year recurrence rate of tumor was higher in patients whose AFP level returned to normal within two months after transplantation（P0.001） and tumor diameter was less than 5.0 cm（P=0.001）.Multivariate analysis revealed that tumor diameter（P=0.001,OR=6.456,95%CI： 2.356-17.680）,vascular invasion（P=0.030,OR=10.653,95%CI： 1.248-90.910）,and AFP level before transplantation（P=0.017,OR=2.601,95%CI： 2.196-5.658） were independent risk factors for tumor recurrence.Conclusion More attentions shall be paid to these patients with tumor diameter 5.0 cm,vascular invasion,and AFP level before transplantation ≥400 μg/L,in particular AFP level is beyond normal within two months after transplantation,and anti-tumor therapy shall be given as soon as possible.