不同年龄组肝癌肝移植受者术后复发和预后评价

Recurrence and prognosis of hepatocellular carcinoma after liver transplantation in different age qronps

目的探讨不同年龄组肝癌肝移植受者术后复发和远期预后情况。方法回顾性分析2013年至2017年四川大学华西医院收治的197例肝癌肝移植受者的临床资料,按受者首次发现肿瘤时的年龄划分为18~40岁组(含40岁,39例)和>40岁组(158例)中老年组,使用Kaplan-Meier法比较两组间的总体存活率、无复发存活率以及疾病特异性存活率。采用Cox比例风险模型分析影响肝癌肝移植受者预后的危险因素。结果两组之间的术后肝癌复发率差异有统计学意义(P<0.05);18~40岁组与>40岁组1年、3年总体存活率分别为82.1%、66.7%和86.1%、74.7%(P>0.05);1年、3年疾病特异性存活率分别为94.9%、82.1%和99.4%、91.1%(P>0.05)两组差异无统计学意义;两组1年、3年无复发存活率分别为51.3%、41.0%和73.0%、62.7%(P=0.006)差异有统计学意义;18~40岁组与>40岁组相比,虽然肝癌肝移植术后无复发存活更差,但两者之间的总体存活率(P=0.288)和疾病特异性存活率(P=0.075)差异无统计学意义。Cox多因素分析发现总计甲胎蛋白>400μg/L为三种存活率共同的独立危险因素;肿瘤低分化和微血管侵犯阳性为疾病特异性存活率的独立危险因素。肿瘤低分化及总计肿瘤直径>5 cm为无复发存活率的独立危险因素。结论肝移植仍是18~40岁肝癌的有效的治疗方案之一。

Objective To evaluate the long-term prognosis and recurrence of young liver transplant recipients with hepatocellular carcinoma(HCC).Methods Based upon the database of liver transplantation center,clinical data were retrospectively reviewed for 39 young recipients(18~40 years)and 158 middle-aged and elderly recipients(over 40 years)from 2013 to 2017.The parameters of overall survival(OS),recurrence-free survival(RFS)and disease-specific survival(DSS)were compared between two groups.Cox's proportional hazard model was utilized for evaluating the prognostic factors.Results Significant inter-group difference existed in recurrence rate of HCC.Kaplan-Meier analysis revealed no significant difference in OS rate(1/3-year OS,82.1%,66.7%and 86.1%,74.7%,P>0.05)and DSS rate(1/3-year DSS,94.9%,82.1%and 99.4%,91.1%,P=0.053);RFS rate(1/3-year RFS,51.3%,41.0%and 73.0%,62.7%,P=0.008)showed significant differences;Cox multivariate analysis revealed that AFP>400μg/L was an independent risk factor for OS,DSS and RFS;poorly differentiated tumors and positive micro-vascular invasion(MVI)were independent risk factor for DSS;poorly differentiated tumors and total tumor size>5 cm were independent risk factors for RFS.Conclusions Although RFS of young adult group is worse than that in middle-aged and elderly group after LT,no significant inter-group difference exists in OS or DSS.And LT is still a quite effective treatment for young HCC patients.