肝切除术和肝移植术治疗的肝细胞癌患者3年随访结局比较

Three-year follow-up outcomes of hepatocellular carcinoma patients undergoing liver resection versus liver transplantation

目的比较肝切除术(LR)和肝移植术(LT)两种方法治疗的肝细胞癌(HCC)患者3年的随访结局。方法回顾性分析2009年3月—2014年3月于首都医科大学附属北京佑安医院接受手术治疗的171例HCC患者临床资料,根据治疗方法分为LR组(n=83)和LT组(n=88),比较两组患者的临床资料差异。分类资料组间比较使用χ^2检验。采用Kaplan-Meier生存曲线和log-rank检验分析两组之间无瘤生存期和总生存期的差异;用Cox比例风险模型分别对无瘤生存期和总生存期进行单因素和多因素分析。结果与LR组对比,LT组的单发肿瘤比例(45.78%vs 85.23%)、直径<3 cm的肿瘤比例(15.66%vs 67.05%)、高Child-Pugh分期比例(9.64%vs 26.14%)明显偏高,LT组的肿瘤复发率明显偏低(48.19%vs 32.95%),且差异具有统计学意义(χ^2值分别为29.649、46.383、7.833、4.121,P值分别为<0.001、<0.001、0.005、0.042);LR治疗患者的无瘤生存率是46.02%,而LT治疗患者的无瘤生存率为80.71%,两者比较具有统计学差异(P=0.006);LR治疗患者的总生存率是76.44%,而LT治疗患者的总生存率为86.99%,差异无统计学意义(P=0.219);Cox单因素和多因素分析均显示治疗方法是无瘤生存期的独立危险因素[RR(95%CI)分别为3.383(1.334~8.579)、0.239(0.093~0.612),P值均<0.05],而治疗方法对于总生存期的预测未达到统计学差异(P=0.232)。结论LT更倾向于选择肝功能储备较差的早期肝癌患者,3年无瘤生存率较好。

Objective To investigate the three-year follow-up outcomes of hepatocellular carcinoma patients undergoing liver resection(LR)versus liver transplantation(LT).Methods A retrospective analysis was performed for 171 patients with hepatocellular carcinoma who underwent surgical treatment in Beijing YouAn Hospital,Capital Medical University,from March 2009 to March 2014,and according to the treatment method,they were divided into LR group(n=83)and LT group(n=88).Related clinical data were compared between the two groups.The chi-square test was used for comparison of categorical data between two groups;the Kaplan-Meier survival curve and the log-rank test were used for comparison of disease-free survival and overall survival between two groups,and the Cox proportional hazards model was used for the univariate and multivariate analyses of disease-free survival and overall survival.Results Compared with the LR group,the LT group had a significantly higher proportion of patients with single tumor[45.78%(38/83)vs 85.23%(75/88),χ^2=29.649,P<0.001],tumor size<3 cm[15.66%(13/83)vs 67.05%(59/88),χ^2=46.383,P<0.001],or high Child-Pugh class[9.64%(8/83)vs 26.14%(23/88),χ^2=7.833,P=0.005]and a significantly lower recurrence rate of tumor[48.19%(40/83)vs 32.95%(29/88),χ^2=4.121,P=0.042].There was a significant difference in disease-free survival rate between the LR group and the LT group(46.02%vs 80.71%,P=0.006);the LT group had a higher overall survival rate than the LR group(86.99%vs 76.44%,P=0.219).Both univariate and multivariate analyses showed that treatment method was an independent risk factor for disease-free survival(risk ratio[RR]=3.383,95%confidence interval[CI]:1.334-8.579;RR=0.239,95%CI:0.093-0.612,both P<0.05),but the prediction of overall survival by treatment method did not reach statistical significance(P=0.232).Conclusion LT is recommended for patients with early-stage hepatocellular carcinoma and can achieve a satisfactory three-year disease-free survival rate.