肝癌肝移植术后肾上腺转移患者诊疗分析

The analysis of clinical diagnosis and treatment for adrenal occupying lesions after liver transplantation for hepatocellular carcinoma patients

目的分析肝癌肝移植术后肾上腺转移患者的临床特征、手术疗效及预后影响因素。方法回顾性分析2001年4月至2014年4月就诊于我院肝外科13例肝癌肝移植术后肾上腺占位患者的临床资料,评价肾上腺切除疗效,对可能影响患者预后的因素进行单因素分析。结果肝癌移植术后肾上腺转移患者的中位生存时间为33.6个月,肾上腺转移后中位时间为13.7个月。PET/CT对肝细胞肝癌肾上腺转移的阳性诊断率较高,并且能够发现其他影像学难以发现的极小转移灶。以肾上腺切除为主的综合治疗未能显著提高患者的累积生存率,但可有效延长患者中位生存时间。单因素分析发现肾上腺转移时间、肝硬化程度、原发肝癌肿瘤个数是影响患者预后的因素。结论 PET/CT对肝细胞肝癌肾上腺转移的诊断具有较高的敏感性及特异性。早期发生肾上腺转移患者的预后可能相对较差。采用以手术为基础的综合治疗可以延长患者生存时间,改善生活质量。

Objective To evaluate clinical features, surgical treatment efficacy and prognostic factors of adrenal metastasis patients after liver transplantation for hepatocellular carcinoma （HCC）. Methods A retrospective analysis of clinical data of 13 patients with adrenal occupying lesions after liver transplantation for hepatocellular carcinoma from Apr. , 2001 to Apr. , 2014 was performed. The outcome of adrenalectomy-based integrated treatment and prognostic risk factors were analyzed. Results The median survival time after liver transplantation and adrenal metastasis were 33.6 months and 13.7 months, respectively. PET/CT achieved a high positive diagnosis rate, and detected a tiny HCC adrenal metastasis which was neglected by other imaging tests. There were no significant differences in cumulative survival rates between patients given adrenalectomy and those not, but adrenalectomy resulted in longer median survival time. Univariate analysis found that the interval of adrenal metastasis after liver transplantation, liver cirrhosis and tumor numbers were prognostic risk factors . Conclusions PET / CT is both sensitive and accurate to detect HCC adrenal metastasis.Early-onset adrenal metastasis is associated with patients with adrenalectomy for potential cure indic based integrated treatment in selected patients. prognosis. The survival benefit in ates a therapeutic value of adrenalectomy-