肝移植治疗原发性肝癌194例的临床效果分析及术后肿瘤复发的危险因素

One center＇s experience： survival analysis of 194 cases of liver transplantation for primary hepatocellular carcinoma

目的探讨肝移植治疗原发性肝癌（PHC）的临床效果及术后肿瘤复发的危险因素。方法回顾性分析2005年4月至2011年6月间194例PHC患者接受肝移植的临床病例资料。结果194例受者肝移植后1、3和5年累积存活率分别为92．78％、78．07％、76．80％，术后有37例受者发生肿瘤复发或转移，发生率为19．10（37／194）。单因素分析结果显示，术前肿瘤TNM分期（P=0．026667）、肿瘤直径（P=0．0045）、肿瘤数目（P=0．0318）、血管侵犯（P=0．006059）及甲胎蛋白（AFP）水平（P=0．003426）与肿瘤复发显著相关；多因素分析结果显示，术前肿瘤直径EP=0．0081，比值比（OR）=0．789，95％可信区间（CI）为2．1233～6．124]、血管侵犯（P〈0．001，OR=5．928，95％CI为1．173-86．789）及AFP水平（P=0．019，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。符合米兰标准的受者与符合加州大学旧金山分校（UCSF）标准的受者间存活率和无瘤存活率的差异均无统计学意义（P〉0．05），但均显著高于超UCSF标准的受者（P〈0．01）。结论肝移植是治疗PHC的有效方法，术前肿瘤直径〉8cm、伴有血管侵犯及AFP水平〉400μg／L均严重影响受者肝移植后肿瘤复发及存活率；合理选择肝癌肝移植手术适应证可使更多PHC患者受益。

Objective To investigate the significance of orthotopic liver transplantation in the management of primary hepatocellular carcinoma （ PHC）; To evaluate the survival and prognostic factors of liver transplantation for PHC. Method The clinical data from 194 consecutive PHC patients who underwent OLT were retrospectively analyzed. Result The 1-, 3- and 5-year cumulative survival rate of the 194 patients was 92. 78%,78. 07% and 76. 80% respectively. There were 37 cases of recurrence or metastasis of the tumor with the incidence rate being 19. 1% （37/194）. The tumor TNM stage （P = 0. 026 667）, tumor diameter （P = 0. 0045）, tumor number （P = 0. 0318）, vascular invasion （P = 0. 006 059）, and AFP level before transplantation （P = 0. 003 426） were significantly related with tumor recurrence. Multivariate analysis revealed that tumor diameter （P = 0. 0081, OR = 0. 789,950% CI：2. 1233-6. 124） ,vascular invasion （P〈0. 001 ,OR= 5. 928,95% CI 1. 173-86. 789） ,and AFP level before transplantation （P = 0. 019, OR = 2. 601,95% CI： 2. 196-5. 658） were independent risk factors for tumor recurrence. There was statistically significant difference in survival rate and tumor-free survival rate between Milan criteria group and beyond-UCSF criteria group （P〈0. 01）, and between UCSF criteria group and beyond-UCSF criteria group （P〈0. 01）. There was no significant difference in survival rate and tumor-free survival rate between Milan criteria group and UCSF criteria group （P 〉0. 05）. Conclusion Liver transplantation is an effective treatment for PHC. The tumor diameter 〉8 cm, vascular invasion and AFP level significantly affect the survival of PHC patients.