脂肪供肝对肝癌肝移植预后的作用研究

The effect of fatty liver on the prognosis of liver transplantation for hepatocellular carcinoma

目的评估脂肪供肝对肝癌肝移植患者肿瘤复发及生存的作用影响。方法回顾性分析2015年1月1日至2018年12月31日在上海交通大学医学院附属仁济医院肝脏外科因肝细胞癌行肝移植治疗的248例患者资料,其中供肝为非脂肪供肝有217例,脂肪供肝为31例。通过收集患者病例资料和肿瘤特点,我们对总体生存率和无复发生存率进行统计分析,评估脂肪供肝对肝癌肝移植患者肿瘤复发及生存的作用影响及危险因素。结果在248例接受肝移植术的肝癌患者中,31例采用了脂肪供肝,脂肪供肝受者与非脂肪供肝受者在年龄、术前甲胎蛋白、性别、乙肝病毒感染、肝硬化、肿瘤个数、肿瘤最大直径、病理分级等方面无显著性差异。脂肪供肝受者与非脂肪供肝受者在1年、3年总体生存率和无复发生存率方面无显著性差异。进一步按照术前是否符合UCSF肝癌肝移植标准进行亚组分类后显示,符合UCSF标准的不同供肝患者总体生存率和无复发生存率无显著性差异。不符合UCSF标准的不同供肝患者的总体生存率无显著差异,但无复发生存率存在显著性差异,且脂肪供肝组的1年、3年无复发生存率较低。结论脂肪供肝受者在1、3年总体生存率和无复发生存率、术后肝功能恢复等方面均与对照组患者无显著性差异,因此轻度脂肪供肝在肝癌肝移植治疗中是安全可行的。同时我们观察到在超出UCSF标准的较大肿瘤、或多发肿瘤患者中,接受脂肪供肝患者的无复发生存率较非脂肪供肝受者低,因此超出UCSF标准的肝细胞癌患者应当尽量避免进行脂肪供肝的肝移植手术。我们期望在对脂肪供肝的脂肪程度进行分级并结合肿瘤分期,患者危险因素等进行更加细致的分层研究后,可进一步扩大供肝范围,合理化供肝分配,使更多的肝癌肝移植患者获益。

Objective To evaluate the influence of fatty donor liver on the recurrence of liver cancer and survival of patients after liver transplantation. Methods A retrospective analysis was performed from the data of 248 patients who underwent liver transplantation for hepatocellular carcinoma from January 1,2015 to December 31,2018,at Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine. Two hundred and seventeen cases were non-fatty donor livers and 31 cases were fatty donor livers. Statistical analysis was performed on overall survival rate and recurrence-free survival rate by collecting patients’ data and tumor characteristics, the influence of fatty donor liver on the tumor recurrence and survival of patients after liver transplantation was also evaluated. Results Among the 248 liver cancer patients who underwent liver transplantation, 31 received fatty donor livers. There were no significant differences in age, gender, hepatitis B infection, liver cirrhosis, number of tumors, tumor maximum diameter, pathological grade. There were no significant differences in overall survival rate and recurrence-free survival rate bewteen patients with fatty livers and non-fatty donor livers. Further subgroup classification was done according to whether the patients met the UCSF criteria before the operation, the overall survival rate and recurrence-free survival rate of the two groups of patients who met the UCSF criteria were not significantly different. There was no significant difference in the overall survival rate in patients who did not meet the UCSF criteria, but there was a significant difference in the recurrence-free survival rate, and the 1-year and 3-year recurrence-free survival rates in which the fatty liver group were lower. Conclusion There was no significant difference between the 1-and 3-year overall survival rate,recurrence-free survival rate and postoperative liver function recovery of fatty liver recipients compared with the control group. Therefore,fatty donor liver is safe and feasible for liver cancer liver transplantation. At the same time,we have observed that in patients beyond UCSF criteria,fatty donor liver seems to have an impact on the prognosis of the patient. More detailed stratification of fat degree of fatty donor liver in combination with tumor stage and patient’s risk factors are needed,this can be an evidence of the expansion of donor source so as to benefit more hepatocellular carcinoma patients.