影响肝癌肝移植预后的高危因素分析及诊治经验

目的分析影响肝癌肝移植预后的临床病理因素,总结临床诊治经验.方法对198例肝癌肝移植患者临床病理特征进行生存率、无瘤生存率的比较（单因素分析）,并通过Cox多因素分析得到有独立意义的预后指标.结果198例肝癌肝移植患者0.5年、1年、2年生存率为89%、78%、65%,无瘤生存率为85%、73%、67%.单因素分析提示肿瘤大小、肿瘤侵犯血管程度、病理Edmondson分级、TNM分期、术前甲胎蛋白（AFP）影响患者无瘤生存率,并且前四个因素与患者生存率相关.Cox多因素分析示肿瘤侵犯血管是影响患者生存和肿瘤复发的独立因素.结论肿瘤侵犯血管是影响肝癌肝移植患者预后的重要因素,术前如何筛选出已有微小转移灶的患者以及如何在移植后预防肿瘤复发是肝癌肝移植发展的重要方向.

Analysis of the risk factors influencing the prognosis of orthotopic liver transplantation for hepatocellular carcinoma and summary of relevant clinical experience

Objective To analyze the risk factors influencing the prognosis of orthotopic liver transplantation for hepatocellular carcinoma (HCC) and sum up the relevant clinical experience in diagnosis and treatment of HCC. Methods The clinical data of 198 HCC patients, 177 males and 21 females, aged 49 (24~83), were analyzed. Results The 0.5-, 1-, and 2-year survival rates were 89%, 78%, and 65 respectively. The rates of disease-free survival (DFS) were 85%, 73, and 67% respectively. Univariate analysis revealed that tumor size, presence of vascular invasion, Edmondson grade, TNM classification, and preoperative alpha-fetoprotein (AFP) were significantly related to DFS, and the 4 foregoing factors were also related to the survival rate. Cox regression analysis suggested that presence of vascular invasion was an independent prognostic factor of survival rate and DFS. Conclusion Vascular invasion plays a leading role in evaluating the prognosis of orthotopic liver transplantation for HCC. It is important to discover the micro-metastasis and explore more effective approaches to prevent recurrence after transplantation.