肝细胞癌肝移植89例预后分析

目的　总结肝细胞癌(HCC)肝移植临床经验,探讨HCC肝移植的预后影响因素。方法　应用单因素分析和逐步Logistic回归多因素分析方法,回顾性分析自1999年1月至2003年12月我单位施行的89例HCC肝移植患者的生存情况及各项临床病理指标对预后的影响。结果　移植后6个月、1年和2年累积生存率分别为81. 8%、55. 3%和43 .7%, 6个月、1年和2年无瘤生存率分别为62 .4%、35. 6%和24 .9%;随访期间肿瘤转移复发的总发生率为52 8%;Log rank检验结果显示,影响HCC患者肝移植术后累积生存率的因素为门静脉主干或分支癌栓形成(PVTT) (χ2 =15 14,P=0. 0001)、肿瘤大小(χ2 =15. 05,P=0 .0001 )、肝硬化背景(χ2 =6 14,P=0 .0132 )、术前甲胎蛋白(AFP)水平(χ2 =5 .82,P=0. 0159)和组织学分级(χ2 =4. 61,P=0 .0319);影响无瘤生存率的因素包括PVTT(χ2 =26 .30,P<0. 0001 )、肿瘤大小(χ2 =25 .25,P<0 0001 )、AFP水平(χ2 =14. 83,P=0 .0001)、组织学分级(χ2 =12 54,P=0. 0004 )、肿瘤分布(χ2 =12 73,P=0. 0004 )、肿瘤数目(χ2 =9 81,P=0 0017)以及肝硬化背景(χ2 =9 .76,P=0 .0018)。多因素分析结果显示,与累积生存率显著相关的因素是PVTT(RR=4. 721,P=0. 001 )、年龄(RR=3. 282,P=0 .007 )和组织学分级(RR=2. 368,P=0.

Liver transplantation for hepatocellular carcinoma: prognostic analysis of 89 cases

OBJECTIVE: To summarize the experience of liver transplantation (LT) for hepatocellular carcinoma (HCC) in one center and identify prognostic factors for survival. METHODS: The clinical data and survival results of 89 patients with HCC receiving LT from January 1999 to December 2003 were retrospectively analyzed and various clinicopathologic risk factors for actuarial survival and tumor free survival were evaluated by univariate and multivariate analysis. RESULTS: Six-month, 1-, and 2-year survival rates were 81.8%, 55.3% and 43.7%, respectively. The 6-month, 1-, and 2-year tumor free survival rates were 62.4%, 35.6% and 24.9%, respectively. The overall tumor recurrence and metastasis rate was 52.8%. In the univariate analysis, portal vein tumor thrombi (PVTT) (chi(2) = 15.14, P = 0.0001), tumor size (chi(2) = 15.05, P = 0.0001), hepatic cirrhosis background (chi(2) = 6.14, P = 0.0132), preoperative alpha-fetoprotein (AFP) level (chi(2) = 5.82, P = 0.0159) and histopathologic grading (chi(2) = 4.61, P = 0.0319) were found to be significantly associated with actuarial survival rate. Seven factors influencing tumor free survival included PVTT (chi(2) = 26.30, P < 0.0001), tumor size (chi(2) = 25.25, P < 0.0001), preoperative AFP level (chi(2) = 14.83, P = 0.0001), histopathologic grading (chi(2) = 12.54, P = 0.0004), tumor distribution (chi(2) = 12.73, P = 0.0004), number of nodules (chi(2) = 9.81, P = 0.0017) and cirrhosis background (chi(2) = 9.76, P = 0.0018). In the multivariate Cox regression analysis, the prognostic factors independently associated with patient survival were identified to be PVTT (RR = 4.721, P = 0.001), age (RR = 3.282, P = 0.007) and histopathologic grading (RR = 2.368, P = 0.037). For tumor free survival, histopathologic grading (RR = 3.739, P < 0.0001), PVTT (RR = 4.382, P = 0.001), cirrhosis background (RR = 0.421, P = 0.011), age (RR = 2.312, P = 0.027) and AFP (RR = 2.301, P = 0.047) were identified as prognostic parameters. CONCLUSIONS: LT is a good therapeutic option for strictly selected patients with HCC. PVTT and histopathologic grading are the most important factors of predicting outcomes of HCC patients undergoing LT. Further studies should be strengthened to establish a reliable and feasible selection criteria and an optimal prognosis scoring system for LT.