有效的术前治疗可以改善超Milan标准肝癌肝移植患者长期生存

Effective pretransplant therapy can improve long-term survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria

目的探索术前治疗对超Milan标准肝癌肝移植患者长期生存的影响。方法回顾性分析2007年1月至2018年12月期间接受肝移植术的114例肝癌患者的临床病例资料。Kaplan-Meier法绘制生存曲线,并行Log-rank检验。结果114例患者中,46例患者复发,42例患者死亡。术前治疗组和非术前治疗组患者术后无复发生存率和总生存率差异无统计学意义。在42例超Milan标准患者中,术前治疗患者的术后1、3、5和8年无复发生存率分别为74.1%、47.1%、47.1%和47.1%,非术前治疗患者的术后1、3、5和8年无复发生存率分别为26.7%、13.3%、13.3%和13.3%(P=0.002);术前治疗患者的术后1、3、5和8年总生存率分别为88.9%、70.0%、63.0%和54.0%,非术前治疗患者的术后1、3、5和8年总生存率分别为80.0%、26.7%、13.3%和13.3%(P=0.004)。超Milan标准患者中,术前治疗有效组预后显著优于未治疗及治疗无效组。结论有效的术前治疗可以改善超Milan标准肝癌患者肝移植术后长期生存。

Objective To explore the effect of preoperative treatment on long-term survival in patients with super Milan standard liver transplantation for hepatocellular carcinoma(HCC).Methods The clinical data of 114 patients with HCC who received liver transplantation from January 2007 to December 2018 were retrospectively analyzed.Kaplan-meier method was used to draw the survival curve,and log-rank test was conducted in parallel.Results Of 114 patients,46 relapsed and 42 died.There was no significant difference in postoperative recurrence free survival rate and overall survival rate between the preoperative treatment group and the non-preoperative treatment group.Among the 42 patients with super Milan standard,the postoperative 1,3,5,and 8-year relapse-free survival rates of patients treated preoperatively were 74.1%,47.1%,47.1%,and 47.1%,respectively.The 1,3,5 and 8-year recurrence free survival rates of patients without preoperative treatment were 26.7%,13.3%,13.3%and 13.3%(P=0.002),respectively.The 1,3,5,and 8-year overall survival rates were 88.9%,70.0%,63.0%,and 54.0%,respectively,in patients treated preoperatively,and 80.0%,26.7%,13.3%,and 13.3%,respectively,in patients not treated preoperatively(P=0.004).In patients with the super Milan standard,the prognosis of the group with effective preoperative treatment was significantly better than that of the group with no treatment and no treatment.Conclusion Effective preoperative therapy improves long-term survival after liver transplantation in patients with super Milan standard liver cancer.