肝癌肝移植术后复发和转移特点及预后因素分析

Recurrence and metastasis profiles of hepatocellular carcinoma after liver transplantation and analysis of prognostic factors

目的探讨肝细胞癌肝移植术后肿瘤复发和转移的特点,分析影响其预后的危险因素。方法回顾性分析2007年6月至2010年10月中山大学附属第一医院121例肝细胞癌行肝移植病人的临床资料和随访结果。应用Kaplan-meier法统计术后累积存活率,利用Log-Rank检验对各项临床病理指标做单因素分析,利用Cox比例风险回归模型进行多因素分析。结果单因素分析显示:肿瘤大小、个数、分布、术前AFP水平、Edmonson分级、门静脉侵犯、pTNM分期与预后有关;Cox风险回归模型多因素分析显示:肿瘤大小、Edmonson分级、门静脉侵犯是影响病人预后的独立危险因素。结论肝细胞癌仍然是肝移植的一个主要适应证。术前肿瘤大小、Edmonson分级、门静脉侵犯是影响肝癌肝移植病人预后的最主要因素;严格筛选受体,可使病人获得长期存活。

Objective To explore the features of recurrence and metastasis of hepatocellular carcinoma （HCC） after liver transplantation, and analyze the risk factors influencing prognosis. Methods The clinical and follow-up data of 121 patients who underwent liver transplantation for HCC between June 2007 and October 2010 in the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. The Kaplan-meier method was used to evaluate the cumulative survival rate. Log-rank test and Cox regression model were performed to analyze clinical pathologic risk factors by univariate and multivariate analysis respectively. Results In the univariate analysis, tumor size, number and location, preoperative alpha-fetal protein （AFP） level, Edmondson pathologic classification, portal vein invasion and pTNM stage were found to be associated with the overall survival rate significantly. The multivariate analysis revealed that tumor size, Edmondson pathologic classification and portal vein invasion were the most independent, statistical and significant factors affecting survival. Conclusion HCC is still one of the main indications of liver transplantation. Tumor size, Edmondson pathologic classification and portal vein invasion are the major prognostic factors after liver transplantation. Recipients can get a long-term survival if transplant candidates are selected strictly.