原发性肝细胞癌肝移植预后相关因素的单中心研究

Single center study on the related factors of prognosis of liver transplantation in hepatocellular carcinoma patients

目的了解原发性肝细胞癌(PHC)患者肝移植术后的临床病理因素和生存情况,分析影响其预后的危险因素。方法回顾性分析2015年1月至2016年12月中山市人民医院29例PHC肝移植患者临床资料,统计患者病理特征、围手术期效果和临床结局。对随访资料采用寿命表及Kaplan-Meier方法绘制生存曲线进行生存分析,筛选差异变量纳入Cox回归模型分析,研究影响PHC肝移植患者预后相关因素。结果29例PHC患者中采取经典原位肝移植25例,背驮肝移植4例。中位随访时间为23个月,失访3例,7例死于复发,生存时间为676.5(26~1188)d,生存率为73.1%(19/26)。Cox回归分析结果显示,病理分级(P=0.018,95%CI:1.758~361.593)及淋巴结转移(P=0.003,95%CI:0.019~0.438)是影响26例患者预后生存的危险因素,病理分级每升高1级,其预后风险降低0.092倍,淋巴结转移患者预后风险升高25.216倍。结论肿瘤病理分级、淋巴结转移是影响PHC肝移植预后的重要因素。判断PHC肝移植预后,需要考虑患者淋巴结转移情况以及术后病理生理改变。

Objective To investigate the clinicopathological factors and survival of patients with primary hepatocellular carcinoma(PHC) with liver transplantation, and to analyze the risk factors affecting their prognosis. Methods From January 2015 to December 2016, the clinical data of twenty-nine patients with liver transplantation for PHC in Zhongshan People’s Hospital were retrospectively analyzed. Pathological features, clinical outcomes and perioperative effects were analyzed. Life table and KaplanMeier method were used for survival analysis of follow-up data, and differential variables were included in Cox regression model analysis to study the related factors affecting the prognosis of liver transplantation patients. Results Twenty-five cases received classical orthotopic liver transplantation and four cases received piggyback liver transplantation. The median follow-up time was 23 months, three cases were lost and seven cases died of recurrence. The survival time was 676.5(26-1 188) days and the survival rate was 73.1%(19/26). Cox regression analysis showed that pathological stage(P=0.018, 95% CI: 1.758-361.593) and lymph node metastasis(P=0.003, 95% CI: 0.019-0.438) were risk factors for prognosis and survival. The prognostic risk of patients with lymph node metastasis increased by 25.216 times, and decreased by 0.092 times for each grade of pathological stage. Conclusions Tumor pathological staging and lymph node metastasis are important factors affecting the prognosis of liver transplantation for PHC. To judge the prognosis of liver transplantation for PHC, lymph node metastasis and pathophysiological changes should be considered.