活体肝移植治疗肝细胞癌

Living donor liver transplantation for hepatoceilular carcinoma

目的探讨活体肝移植治疗肝细胞癌的疗效及其影响因素。方法回顾分析180例肝癌患者接受肝移植治疗（活体肝移植34例，尸体肝移植146例）的临床资料，比较受者术后肿瘤复发率、总体存活率及无瘤存活率，并通过单因素和多因素分析明确其影响因素。结果尸体肝移植受者术后5年的总体存活率和无瘤存活率分别为53％和58％，活体肝移植者均为60％，两组间比较，差异无统计学意义（P〉0．05）。活体肝移植和尸体肝移植术后肝癌的复发率分别为26．5％和17．8％，两组间比较，差异也无统计学意义（P＞0．05）。经COX多因素分析显示，肿瘤血管侵犯（相对危险度2．118，95％可信区间1．201～4．353，P％0．05）和是否符合UCSF标准（相对危险度3．490，95％可信区间1．862-8．207，P％0．05）是影响肝癌复发的独立危险因素，而影响受者术后存活率的独立危险因素为是否符合UCSF标准（相对危险度8．573，95％可信区间3．016～18．261，P％0．01）。结论活体肝移植是治疗肝细胞癌的一项安全、有效的措施，但受者的选择标准和术后肝癌的高复发率现象需要进一步的临床和基础研究。

Objective To evaluate the outcome of living donor liver transplantation （LDLT） for bepatocellular carcinoma （HCC）. Methods We retrospectively analyzed the clinical data of 180 patients, who bad received LDLT （n = 34） or deceased donor liver transplantation （DDLT, n = I46） for HCC, compared overall and recurrence-free survival between LDLT and DDLT, and identified the risk factors of tumor recurrence and prognosis by univariate and multivariate analysis. Results The 5year overall survival and recurrence-free survival rate were 53%and 58%, respectively, in DDLT group, and 60% and 60%, respectively, in LDLT group. There was no significant difference in overall （P = 0. 85） and recurrence-free （P = 0. 89） survival between these two groups. The tumor recurrence rate was 26. 5% in LDLT group, and 17. 8% in DDLT group, respectively （P = 0. 25）. Multivariate COX regression model analysis identified vascular invasion （relative risk 2.118, 95 confidential interval 1. 201-4. 353, P= 0. 032） and tumor beyond UCSF criteria （relative risk 3. 490, 95% confidential interval 1. 862-8. 207, P = 0. 015） as independent risk factors of tumor recurrence, and tumor beyond UCSF criteria （relative risk 8. 573, 95% confidential interval 3. 016-18. 261, P = 0. I）06） as independent predictors of prognosis. Conclusion LDLT is a safe and effective procedure for patients with HCC, but further studies are required for selection criteria of recipients and higher HCC recurrence rate after LDLT.