符合杭州标准肝癌肝移植受者术前接受经导管动脉化疗栓塞术治疗对术后疗效影响临床分析

目的分析符合杭州标准肝癌肝移植受者术前接受经导管动脉化疗栓塞术(TACE)治疗对术后肿瘤复发和受者生存情况的影响。 方法回顾性分析2008年1月至2018年12月在中国人民解放军联勤保障部队第九〇〇医院收治的92例符合杭州标准并行肝移植治疗的肝移植受者临床资料，所有受者均经术后病理检查证实为肝细胞癌。根据受者肝移植术前是否接受TACE治疗将其分为TACE治疗组(n＝58)和直接移植组(n＝34)。符合正态分布计量资料采用成组t检验比较，不符合正态分布计量资料采用Mann-Whitney U检验比较，计数资料采用卡方检验或Fisher确切概率法比较。采用Kaplan-Meier法进行生存分析，并采用log-rank检验进行比较。P<0.05为差异有统计学意义。 结果随访截至2021年12月31日，92例受者术后平均随访时间为(77±48)个月，随访期间共32例受者肿瘤复发。92例受者中9例术前合并门静脉癌栓(PVTT)，术前影像学检查均未发现有门静脉侵犯，术后病理提示存在微静脉癌栓，均属于PVTT Ⅰ₀型，9例受者中6例移植术后肿瘤复发，平均无瘤生存时间为(51±48)个月，7例死亡，平均生存时间为(62±43)个月。TACE治疗组受者术后1、3和5年生存率分别为96.6%、84.5%和82.8%，直接移植组分别为91.2%、67.6%和61.8%，两组受者术后1、3年生存率差异均无统计学意义(χ²＝1.205和3.571，P均>0.05)；两组受者术后5年生存率差异有统计学意义(χ²＝5.039，P<0.05)。TACE治疗组受者术后1、3和5年无瘤生存率分别为87.9%、77.6%和75.9%，直接移植组分别为76.5%、58.8%和52.9%，两组受者术后1、3年无瘤生存率差异均无统计学意义(χ²＝2.063和3.639，P均>0.05)；两组受者术后5年无瘤生存率差异有统计学意义(χ²＝5.124，P<0.05)。两组受者术后生存率及术后无瘤生存率差异均有统计学意义(χ²＝5.013和5.406，P<0.05)。 结论对于符合杭州标准的肝癌肝移植受者，术前接受TACE治疗可能改善移植术后长期疗效。

Postoperative efficacy of preoperative transcatheter arterial chemoembolization therapy for liver transplant recipients with hepatocellular carcinoma meeting Hangzhou criteria

ObjectiveTo compare the effect of transcatheter arterial chemoembolization (TACE) therapy on tumor recurrence and survival in liver transplant recipients with hepatocellular carcinoma (HCC) who met Hangzhou criteria. MethodsThe clinical data of 92 liver transplant recipients with HCC who met the Hangzhou criteria and underwent liver transplantation in the 900th Hospital of the Joint Support Force of Chinese People′s Liberation Army from January 2008 to December 2018 were retrospectively analyzed. All recipients were confirmed to have HCC by postoperative pathological examination. Recipients were divided into TACE treatment group (n=58) and direct transplantation group (n=34) according to whether they received TACE treatment before liver transplantation. Measurement data conforming to normal distribution were compared by group t test, measurement data not conforming to normal distribution were compared by Mann-Whitney U test, and enumeration data were compared by chi-square test or Fisher exact test. Survival analysis was performed using the Kaplan-Meier method and compared using the log-rank test. P<0.05 was considered statistically significant. ResultsDuring the follow-up until December 31, 2021, the average postoperative follow-up time of 92 recipients was (77±48) months, and a total of 32 recipients had tumor recurrence during the follow-up period. Nine of the 92 recipients had preoperative portal vein tumor thrombus (PVTT), none of whom were found to have portal vein invasion by preoperative imaging, and postoperative pathology revealed the presence of venular tumor thrombus, which belonged to PVTT type Ⅰ₀. Of the 9 recipients, 6 had tumor recurrence after transplantation, with a mean disease-free survival time of (51±48) months, and 7 recipients died, with a mean survival time of (62±43) months. The survival rates at 1, 3 and 5 years after operation were 96.6%, 84.5% and 82.8% in TACE group and 91.2%, 67.6% and 61.8% in direct transplantation group, respectively. There was no significant difference in the survival rates at 1 and 3 years after operation between the two groups (χ²=1.205 and 3.571, all P>0.05). There was significant difference in the survival rate at 5 years after transplantation between the two groups (χ²=5.039, P<0.05). The postoperative 1-, 3- and 5-year disease-free survival rates were 87.9%, 77.6% and 75.9% in TACE group and 76.5%, 58.8% and 52.9% in direct transplantation group, respectively. There was no significant difference in the postoperative 1- and 3-year disease-free survival rates between the two groups (χ²=2.063 and 3.639, all P>0.05). There was significant difference in the postoperative 5-year disease-free survival rate between the two groups (χ²=5.124, P<0.05). There were significant differences in the postoperative survival rate and postoperative disease-free survival rate between the two groups (χ²=5.013 and 5.406, all P<0.05). ConclusionFor liver transplant recipients with liver cancer who meet Hangzhou criteria, preoperative TACE treatment may improve the long-term efficacy after transplantation.