影响肝癌患者肝移植术后复发和预后的因素分析

Analysis of factors affecting recurrence and prognosis of liver transplantation in patients with hepatocellular carcinoma

目的探讨肝癌肝移植患者长期疗效及预后相关的危险因素。方法回顾性分析2003年到2018年肝移植治疗的165例肝癌患者的临床病例资料。Kaplan-Meier法绘制生存曲线,差异行Log-Rank检验。采用Logistic回归模型分析影响肝移植术后复发的因素。采用Cox风险回归模型分析影响肝移植预后的因素。结果全组中位随访时间为76. 4个月,64例患者复发,64例患者死亡,101例患者存活。165例患者1、3和5年无复发生存率分别为70. 3%、60. 7%和57. 8%;1、3和5年总生存率分别是87. 9%、66. 7%和62. 9%。Milan标准组无复发生存率和总体生存率均高于非Milan标准组。多因素Logistic回归分析显示:肿瘤直径>5 cm、肿瘤数目≥3个、MVI阳性和低分化是肝移植患者术后肝癌复发的独立危险因素。多因素Cox回归分析显示:AFP>400μg/L、肿瘤直径>5 cm、肿瘤数目≥2个和MVI阳性是肝移植患者术后OS的独立危险因素。结论肝移植可使肝癌患者获得长期生存。AFP、肿瘤直径、肿瘤数目和MVI是影响预后的独立危险因素。

Objective To investigate the long-term efficacy and prognostic risk factors of liver transplantation in patients with hepatocellular carcinoma(HCC).Methods The clinical data of 165 patients with liver cancer treated by liver transplantation from 2003 to 2018 were retrospectively analyzed.The survival curve was drawn by Kaplan-Meier method,and the difference line was tested by log-rank.Logistic regression model was used to analyze the factors affecting recurrence after liver transplantation.COX risk regression model was used to analyze the factors affecting the prognosis of liver transplantation.Results The median follow-up time of the whole group was 76.4 months,64 patients relapsed,64 patients died,and 101 patients survived.The 1-year,3-year and 5-year relapse-free survival rates of 165 patients were 70.3%,60.7%and 57.8%,respectively.The 1-year,3-year and 5-year overall survival rates were 87.9%,66.7%and 62.9%,respectively.The recurrence-free and overall survival rates of the Milan standard group were higher than those of the non-milan Standard group.Multivariate logistic regression analysis showed that tumor diameter>5 cm,tumor number≥2,positive MVI and low differentiation were independent risk factors for HCC recurrence in patients after liver transplantation.Multivariate Cox regression analysis showed that AFP>400 g/L,tumor diameter>5 cm,tumor number≥2 and MVI positive were independent risk factors for OS in patients after liver transplantation.Conclusion Liver transplantation can provide long-term survival for patients with liver cancer.AFP,tumor diameter,tumor number and MVI were independent risk factors for prognosis.