单中心肝细胞癌患者肝移植术后长期生存情况分析

Long-term survival after liver transplantation in hepatocellular carcinoma patients:a single-center experience

目的分析肝细胞癌患者肝移植术后长期生存及肿瘤复发情况以及预后影响因素。方法回顾性分析2000年5月1日至2012年5月1日在北京大学人民医院肝胆外科因原发性肝癌进行肝移植手术的228例患者资料,共有166例患者满足入组条件。收集患者围手术期及随访资料,分析其总体生存率、无瘤生存率及其影响因素。结果166例肝细胞癌患者肝移植术后1、5、10年总体生存率和无瘤生存率分别为80.7%、52.4%、45.8%和60.2%、47.6%、44.0%,其中符合加州大学旧金山分校(University of California,San Francisco,UCSF)标准患者共96例,术后1、5、10年总体生存率和无瘤生存率分别为83.3%、66.7%、59.4%和74.0%、62.5%、57.3%。多因素分析发现,超出UCSF标准、移植前甲胎蛋白(alpha fetoprotein,AFP)≥400 ng/ml及组织学低分化是影响总体生存率及无瘤生存率的独立危险因素,差异有统计学意义(均P<0.05)。结论肝移植是治疗肝细胞癌的有效手段。除了肿瘤大小及个数之外,移植前AFP≥400 ng/ml及组织学低分化也是肝细胞癌患者预后不良的高危因素。

Objective To analyze the long-term cumulative survival and tumor-free survival of hepatocellular carcinoma(HCC)patients after liver transplantation,as well as the influencing factors.Methods We conducted a retrospective study on 228 HCC patients receiving liver transplantation from May 1,2000 to May 1,2012 at the Department of Hepatobiliary Surgery,Peking University People's Hospital.A total of 166 patients met the recruit criteria.The patients'perioperative data and follow-up data were collected.We analyzed the cumulative survival and tumor-free survival of the recipients,as well as the influencing factors.Results The 1-,5-and 10-year cumulative survival of the 166 HCC patients were 80.7%,52.4%and 45.8%,respectively,while the 1-,5-and 10-year tumor-free survival of these patients were 60.2%,47.6%and 44.0%,respectively.Among these patients,a total of 96 recipients met the University of California,San Francisco(UCSF)criteria,whose 1-,5-and 10-year cumulative survival were 83.3%,66.7%,and 59.4%,respectively,and tumor-free survival were 74.0%,62.5%and 57.3%,respectively.Multivariate analysis showed that beyond the UCSF criteria,alpha fetoprotein(AFP)≥400 ng/ml before transplantation and poorly differentiated carcinoma were independent factors affecting cumulative survival and tumor-free survival(P<0.05).Conclusions Liver transplantation is an effective treatment of HCC.Besides the size and the number of the tumors,AFP≥400 ng/ml before transplantation and poorly differentiated tumors are independent factors affecting the long-term cumulative survival and tumor-free survival of HCC patients.