微血管侵犯对肝细胞癌肝移植术后预后的影响

Effect of the microvascular invasion on the prognosis of hepatocellular carcinoma after liver transplantation

目的:探讨微血管侵犯(microvascular invasion,MVI)对肝细胞癌(HCC)肝移植术后预后的影响。方法:回顾性分析HCC行原位肝移植手术病人183例的临床和随访资料,其中符合米兰标准76例,USCF标准84例,上海标准102例,杭州标准126例。用Kaplan-Meier法计算4组1年、3年、5年累积生存率,并用Log-Rank检验比较各组生存曲线的差异。将每组分为MVI和无MVI亚组,比较肿瘤复发率、5年无瘤生存率及1年、3年、5年生存率。结果:4组病人的生存时间差异均无统计学意义(P>0.05);随着HCC肝移植标准扩大,MVI率逐渐升高(P<0.05),3年、5年生存率和5年无瘤生存率均逐渐降低(P<0.05)。符合上海标准病人中,无MVI亚组肿瘤复发率低于MVI亚组(P<0.05),5年生存率和5年无瘤生存率均高于MVI亚组(P<0.05);符合杭州标准病人中,无MVI亚组肿瘤复发率低于MVI亚组(P<0.05),3年、5年生存率和5年无瘤生存率均高于MVI亚组(P<0.05~P<0.01)。结论:MVI可预测符合上海标准和杭州标准的HCC肝移植术后复发情况,对肝移植综合治疗具有指导意义。

Objective：To investigate the ettects of microvascular invasion（MVI） on the prognosis of hepatocellular carcinoma （ HCC ） alter liver transplantation. Methods：The clinical data of 183 HCC patients treated with orthotopic liver transplantation were retrospec-tively analyzed. Sevenly-six cases according with the Milan standard,84 cases according with USCF standard, 102 cases according with Shanghai standard and 126 cases according with Hangzhou standard were identified. The 1-year, 3-year and 5-year cumulative survival rates in four groups were calculated using Kaplan-Meier method,and the ditterences of survival curves among the four groups were com- pared using Log-Rank test. Each group was subdivided into the MVI group and non-MVI group, and the recurrence rate of tumor,5-year disease-free survival rate, and l-year, 3-year,5-year survival rates were compared between two groups. Results：There was no statistical significance in survival time among four groups （P 〉 0.05 ）. With the expansion of liver transplantation standard, the MVI rate gradually increased, the 3-year, 5-year survival rates and 5-year disease-free survival rate gradually decreased（ P 〈 0.05 ）. Among the patients ac-cording with Shanghai standard, the tumor recurrence rate in non -MVI group was lower than that in MVI group （P 〈 0.05 ） , and the 5-year survival rate and 5-year disease-free survival rate in non-MVI group were higher than that in non-MVI group（ P 〈 0.05 ）. Among the patients according with Hangzhou standard,the tumor recurrence rate in non-MVI group was lower than that in MVI group（P 〈 0. 05 ） , and the 5-year survival rate and 5-year disease-free survival rate in MVI group were higher than that in MVI group （P 〈 0.05 to P 〈 0.01 ）. Conehlsions ： Microvascular invasion can predict the recurrence of HCC after liver transplantation, which has guiding signifi-cance in comprehensive treatment of liver transplantation.