超出UCSF标准肝癌肝移植术后生存情况及预后影响因素分析

Analysis of postoperative survival and prognostic factors of orthotopic liver transplantation for hepatocellular carcinoma beyond UCSF criteria

目的分析超出加利福尼亚大学(UCSF)标准肝癌肝移植病人的生存情况,探讨影响预后的因素。方法对2006年1月至2010年12月间中山大学附属第一医院超过UCSF标准的肝癌肝移植病人的临床病历资料进行回顾性分析,应用Kaplan-Meier法计算病人存活率,应用Log-Rank检验进行单因素分析,应用Cox比例风险模型进行多因素分析,探讨临床和肿瘤病理因素与病人存活率之间的关系。结果单因素分析显示对存活率和(或)无瘤存活率有影响的有:肿瘤Edmondson分级、肿瘤TNM分期和肿瘤门静脉侵犯、术前AFP水平、术前淋巴结转移(P<0.05);Cox回归分析显示,肿瘤Edmondson分级Ⅲ-Ⅳ级和肿瘤门静脉侵犯(P<0.05)是与预后相关的独立因素。结论对于超出UCSF标准的肝癌病人,移植的总体效果是欠佳的,但也有部分病人可获得较长期的存活或带瘤生存,肿瘤Edmondson分级和门静脉侵犯是影响该组病人预后的重要因素。

Objective To explore postoperative survival and prognostic factors of orthotopic liver transplantation （OLT） for hepatocellular carcinoma （HCC） beyond UCSF criteria. Methods The clinical and follow up data of 58 cases of HCC beyond UCSF criteria performed OLT from January 2006 to December 2010 at the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. Survival analysis was performed using Kaplan-Meier, Log＇Rank test and Cox proportional hazards regression methods. Results Univariate analysis showed that tumor Edmondson grade, TNM stage, portal vein tumor thrombi （PVTT）, AFP〉400 μg/L and lymph node metastasis affected the overall survival rate and/or disease free survival rate significantly （P 〈 0.05）. The Cox regression analysis showed that the independent factors associated with prognosis were tumor Edmondson grade Ⅲ/Ⅳ and PVTT （P 〈 0.05）. Conclusion The effect of OLT for HCC beyond UCSF criteria is disappointing. But some cases can achieve long term survival. Tumor Edmondson grade Ⅲ/Ⅳ and PVTT are important predictive factors of poor prognosis.