层粘连蛋白预测HBV感染相关性肝癌肝移植术后肿瘤复发的临床意义

Laminin may be a predictor of recurrence after liver transplantation for HBV -related hepatocellular carcinoma patients

目的探讨层粘连蛋白(LN)与乙型肝炎病毒(HBV)感染相关性肝癌(HCC)肝移植术后肿瘤复发的相关性及意义。方法251例HBV感染相关性HCC患者接受了肝移植,采集病肝组织,应用免疫组化法检测肝癌组织中LN的表达情况,采用Spearmanrank检验,Kaplan-Meier和Log-rank检验以及多因素Cox回归方法分析影响术后生存/复发的风险因素。结果LN在肝癌肝窦窦壁/血管内皮上的阳性表达与肿瘤个数(P=0.00)、微卫星灶(P=0.02)、血管侵犯(P=0.048)、TNM分期(P=0.00)、术前AFP水平(P=0.00)、HBV DNA(P=0.02)、HBeAg(P=0.02)、术后复发(P=0.00)有关联性。Log-rank分析显示,LN在肝癌窦壁/血管内皮上不同表达(-,+,≥++)受者间术后1、3、5年总存活率(P<0.05)或无瘤存活率(P<0.05)的差异均有统计学意义。多因素Cox回归分析显示,LN在肝癌窦壁/血管内皮上的强阳性表达(P=0.01)是肝移植术后较差无瘤存活率的独立预测因子。结论LN可能预测HBV相关性HCC肝移植术后肿瘤复发。

Objective To explore the prognostic role of laminin (LN) as a tumor biological marker in predicting the recurrence of hepatocellular carcinoma (HCC) related with HBV infection after liver transplantation (LT). Methods Tissue samples from 251 HBV-related HCC patients undergoing LT were immunohistochemically stained with anti-LN antibody. The relevant prognostic factors were analyzed using Spearman's rank test, Kaplan-Meier method, log-rank test and multivariate step-wise Cox regression analysis. Results The expressions of LN in tumor tissues were significantly positively correlated with tumor number (P=0.00), microsatellite (P=0.02), venous invasion (P=0.048), pTNM tumor stage (P=0.00), pre-LT serum α-fetoprotein (AFP) level (P=0.00), HBV DNA level (P=0.02), HBeAg level (P=0.02) and tumor recurrence (P=0.00) respectively. Significant differences existed in 1/3/5-year overall survival or tumor recurrence-free survival rate post-LT among LN different expression (-,+,≥++) in HBV-related HCC patients (P<0.05). Multivariate analysis indicated that LN was a significantly independent predictor in predicting poor tumor recurrence-free survival post-LT (P=0.01). Conclusions LN may be a feasible marker in predicting HCC recurrence post-LT for HBV-related HCC patients.