肝癌肝移植的预后因素分析

背景与目的：肝移植（liver transplantation,LT）是目前治疗肝细胞癌（hepatocellular carcinoma,HCC）最好的措施,但影响HCC肝移植预后的主要因素和手术指征始终存在争议。明确影响预后的主要因素有助于确定合理的手术指征,进而提高HCC肝移植的生存率。本研究旨在探讨影响HCC肝移植预后的主要因素。方法：回顾性分析1999年2月至2004年12月在四川大学华西医院施行肝移植的98例HCC患者的临床资料和随访结果。用Kaplan—Meier法计算全组的累积生存率,log-rank检验做单因素分析,Cox比例风险回归模型进行多因素分析。结果：全组随访1—78个月,中位随访时间37．6个月;随访期间死亡31例（31．6％）,51例复发（52．0％）。全组病例1年、3年和5年累积生存率分别为84．9％、49．3％和33．2％。单因素分析显示,肿瘤大小、门静脉癌栓（portal vein tumor thrombus．PVTT）、AFP水平、pTNM分期和组织学分级与预后有关：Cox回归多因素分析显示,肿瘤大小和PVTT是影响预后的独立因素。结论：肿瘤大小和PVTT是影响HCC肝移植预后的最主要因素。

Prognostic factors of hepatocellular carcinoma after liver transplantation

BACKGROUND & OBJECTIVE: Liver transplantation (LT) is the best treatment for hepatocellular carcinoma (HCC), however, prognostic factors and selection of patients with HCC for LT are controversial. This study was to summarize our experience of LT for HCC, and identify prognostic factors. METHODS: The clinical and follow-up data of 98 patients who underwent LT for HCC between Feb. 1999 and Dec. 2004 in our center were analyzed retrospectively. Their survival rates were calculated by Kaplan-Meier method. Log-rank test and Cox proportional hazards regression model were performed to analyze prognostic factors of HCC after LT. All statistical evaluations were performed using SPSS10.0 statistical software. RESULTS: The follow-up time ranged from 1 to 78 months (median, 37.6 months). The mortality was 31.6%. The recurrence rate was 52.0%. The 1-, 3-, and 5-year survival rates were 84.9%, 49.3%, and 33.2%, respectively. Univariate analysis showed that portal vein tumor thrombus (PVTT), tumor size, serum alpha-fetoprotein (AFP) level, pTNM stage, and histological differentiation were prognostic factors of HCC after LT. Multivariate Cox regression analysis showed that the tumor size and PVTT were independent prognostic factors of HCC after LT. CONCLUSIONS: Tumor size and PVTT are major prognostic factors of HCC after LT.