影响原发性肝癌肝移植治疗的预后因素分析

目的分析影响肝癌肝移植术后生存率和无瘤生存率的危险因素,探讨国内肝移植治疗肝癌的选择标准。方法对67例接受同种异位原位肝移植治疗的原发性肝癌病人的基本资料和肿瘤相关资料包括术前病情分级、血清AFP水平、术前辅助治疗以及肝癌大小、数目、pTNM分期、肿瘤恶性程度分级等因素进行单因素和多因素分析。结果术后1年、2年累积生存率为77%、67%,6个月和12个月无瘤生存率为66%和58%。单因素分析显示对肝癌肝移植术后累积生存率影响有统计学意义的因素为CHILD分级(MELD积分)和肝外大血管侵犯;多因素分析影响肝癌肝移植术后无瘤生存率有统计学义的因素是肿瘤大小、大血管侵犯和肿瘤分化程度。结论影响肝癌肝移植术后生存率的因素仍是术前患者肝功能状态。对存在大血管侵犯的肝癌患者需严格控制肝移植术适应证,而无血管侵犯的患者在选择肝移植治疗时肿瘤大小指标可较米兰标准适当放宽。

Analysis of factors affecting the prognosis of liver transplantation for hepatocellular carcinoma

Objective To evaluate the risk factors affecting the survival rate and recurrence-free survival rate of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC), and to discuss the selection criteria for liver transplantation within HCC patients in China. Methods The (data) of 67 patients undergoing OLT for HCC at our center were reviewed retrospectively, including CHILD grade, MELD score, pre-transplant serum alphafetoprotein (AFP), pre-transplant adjuvant treatment and tumor size, number, pTNM stage, pathologic tumor stage et al. Results The cumulative 1-year and 2-year survival rate was 77% and 67%. The recurrence-free 6-month and 12-month survival rate was 66% and 58%. Univariate analysis showed that the factors significantly associated with long-term survival rate were CHILD grade (MELD score) and extrahepatic vascular invasion. Multivariate analysis suggested that pathologic tumor stage, tumor size and macro-vascular invasion significantly affected recurrence-free survival rate. Conclusions The liver function status is the main factor that affects the survival rate of HCC patients after liver transplantation. Liver transplantation should be strictly selected for HCC patients with macro-vascular invasion. For the non-vascular invasion HCC patients, tumor size should not be a strict criterion as Milan.