合并微血管侵犯的肝癌肝移植受者的预后评价

Evaluation of clinical prognosis of liver transplant recipients of hepatocellular carcinoma complicated with microvascular invasion

目的探讨合并微血管侵犯(MVI)的肝细胞癌(肝癌)肝移植受者的预后情况。方法通过美国国立癌症研究所的监测、流行病学和最终结果(SEER)数据库提取行肝移植术的3447例肝癌受者的临床资料。根据受者有否MVI分为MVI组(376例)和无MVI组(3071例)。分析比较两组肝移植受者的预后情况,包括术后1、3、5年总生存率(OS)及肝癌特异生存率(LCSS)。纳入两组受者的相关临床资料,包括年龄、性别、人种、病理分化、肿瘤大小、淋巴结转移、远处转移、肿瘤-淋巴结-转移(TNM)分期、MVI,采用多因素Cox模型分析肝癌肝移植受者预后的独立危险因素。绘制预测受者预后的列线图,通过一致性指数评价模型准确度。结果无MVI组受者术后1、3、5年OS和LCSS分别为93.5%、82.1%、75.3%和98.3%、93.8%、90.7%,明显高于MVI组的88.8%、72.1%、68.4%和95.3%、83.1%、80.4%(均为P<0.05)。多因素回归分析显示病理分化、肿瘤大小、淋巴结转移、远处转移、TNM分期以及MVI均是影响肝癌肝移植受者OS与LCSS的独立危险因素(均为P<0.05)。列线图一致性指数为0.624(0.602~0.648)。结论MVI是肝癌肝移植受者预后的独立危险因素,与受者预后不良显著相关,以此为基础构建的列线图可预测患者预后情况。

Objective To investigate the clinical prognosis of the liver transplant recipients diagnosed with hepatocellular carcinoma(HCC)complicated with microvascular invasion(MVI).Methods Clinical data of 3447 HCC recipients undergoing liver transplantation were extracted from Surveillance,Epidemiology,and End Results(SEER)database of American National Cancer Institute.According to the incidence of MVI,all recipients were divided into MVI(n=376)and non-MVI groups(n=3071).The clinical prognosis of liver transplant recipients was statistically compared between two groups by analyzing the 1-,3-and 5-year overall survival(OS)and liver cancer specific survival(LCSS).Relevant clinical data including age,gender,race,pathological staging,tumor size,lymph node metastasis,distant metastasis,tumor-node-metastasis(TNM)staging and MVI were recorded in two groups.The independent risk factors of clinical prognosis of HCC recipients undergoing liver transplantation were analyzed by multivariate Cox regression model.The nomogram for predicting the clinical prognosis of the recipients was delineated.The accuracy of the prediction model was evaluated by the consistency index.Results In the non-MVI group,the 1-,3-,5-year OS and LCSS were 93.5%,82.1%,75.3%and 98.3%,93.8%,90.7%,significantly higher than 88.8%,72.1%,68.4%and 95.3%,83.1%,80.4%in the MVI group(all P<0.05).Multivariate regression analysis showed that pathological staging,tumor size,lymph node metastasis,distant metastasis,TNM staging and MVI were the independent risk factors of OS and LCSS in HCC recipients undergoing liver transplantation(all P<0.05).The nomogram consistency index was calculated as 0.624(0.602-0.648).Conclusions MVI is an independent risk factor of the clinical prognosis of HCC recipients undergoing liver transplantation,which is significantly correlated with poor prognosis of the recipients.The nomogram based on MVI can predict the clinical prognosis of these recipients.