肝部分切除后肝癌复发行肝移植的适应证选择

Indication of salvage liver transplantation

目的探讨肝部分切除后肝癌复发行肝移植的适应证选择。方法回顾性分析2000年6月至2013年3月172例肝部分切除术后肝癌复发行肝移植的受者临床资料。其中符合米兰标准47例，符合加州大学旧金山分校（ucsF）标准62例，符合uptoseven标准70例，符合复旦标准61例，符合杭州标准139例。对5种标准与受者预后的相关性进行风险比例回归分析。根据各标准符合与否进行分组作kaplan-meier生存分析。结果术后1、3和5年存活率：172例受者总体存活率分别为82％、56．4％和51．6％；符合米兰标准者分别为89％、75．1％和70．1％，不符合者为79．6％、52．5％和45．1％；符合uptoseven标准者分别为89．7％、74．8％和67．5％，不符合者为77．2％、48．8％和42．6％；符合UCSF标准者分别为89．3％、71％和59％，不符合者为78．1％、51．8％和47．6％；符合复旦标准者分别为91．8％、77．9％和64．9％，不符合者为77％、49％和44．9％；符合杭州标准者分别为86．1％、66．8％和58．7％，不符合者为64．1％、19．7％和19．7％。各标准两组受者间存活率的差异均有统计学意义（P〈0．05）。92例超米兰标准但符合杭州标准受者术后1、3和5年存活率分别为84．7％、63％和53．9％，与符合米兰标准受者比较，差异无统计学意义（P=0．122）。结论现有肝癌肝移植标准用于肝切除后肝癌复发肝移植的适应证是可行的；在米兰标准基础上其他标准均有效的扩大了患者范围，尤以杭州标准最优，但仍需更大样本量的研究。

Objective To investigate the indications of salvage liver transplantation （liver transplantation for recurrent hepatocellular carcinoma after liver resection）. Method 172 cases of salvage liver transplant patients from June 2000 to March 2013 were analyzed retrospectively. Forty- seven cases of them met the Milan criteria, 62 cases met the University of California San Francisco criteria （UCSF）, 70 cases met the up to sever criteria, 61 cases met the Fudan criteria, and 139 cases met the Hangzhou criteria. Correlation for five kinds of standards and prognosis were analyzed by kaplan-meier survival analysis. Result Total patients 1-, 3-, and 5-year survival rate of salvage liver transplant got 82%, 56. 4%, and 51.6%, respectively. 1-, 3-, and 5-year survival rate of salvage liver transplant patients meeting the Milan criteria was 89%, 75.1%, and 70. 1% respectively, and that not meeting the Milan criteria was 79. 6%, 52. 5%, and 45.1% respectively. 1-, 3-, and 5-year survival rate of liver transplant patients meeting the Hangzhou criteria was 86. 1%, 66. 8% and 58. 7% respectively, and that not meeting the Hangzhou criteria was 64. 1%, 19. 7%, and 19. 7% respectively. 1-, 3- and 5-year survival rate in 92 cases meeting the Hangzhou criteria but not in line with the Milan criteria was 84. 7%, 63% and 53. 9% respectively, and had no statistically significant difference from the similar recipients in line with Milan criteria （P = 0. 122）. Conclusion Using theexisting criteria for hepatocellular carcinoma liver transplantation for salvage liver transplantation is feasible. A better indication of salvage liver transplantation should be found in a wider range of studies and a larger sample size.