晚期肝细胞癌肝移植术后的远期疗效和匹兹堡分级的预测价值

目的 观察晚期原发性肝癌肝移植术后的远期疗效，探讨匹兹堡分级的预测价值。方法 46例不符合米兰标准的晚期肝癌患者接受原位肝移植术，观察其术后的远期疗效。依据匹兹堡标准分为4组（Ⅰ组：1～2级，6例；Ⅱ组：3级，13例；Ⅲ组：4级，17例；Ⅳ组：5级，10例），分别监测各组的远期生存情况，并进行组间比较。结果 46例患者的3年生存率为46．7％，3年的无瘤生存率为38．8％，平均生存期32．5个月，平均无瘤生存期27．7个月。Ⅰ组患者术后无死亡和肿瘤复发，Ⅳ组患者1年无瘤生存率仅12．5％，Ⅱ、Ⅲ组患者的3年无瘤生存率在40％左右，两组之间无明显差异。Ⅱ、Ⅲ组患者的最长无瘤随访时间为58个月。结论 晚期肝癌行肝脏移植术仍有相当的远期疗效。匹兹堡标准对1、2级和5级患者有较好的预测价值，尤其对较早期肝癌的鉴别优于米兰标准，但在3、4级患者的应用有一定的局限性。

Long term result of liver transplantation in patients with advanced hepatocellular carcinoma and the predictability of Pittsburg scoring system

Objective To investigate the long term result of orthotopic liver transplantation for advanced hepatocellular carcinoma, and to evaluate the predictability of Pittsburg scoring system. Methods 46 patients of advanced hepatocellular carcinoma received orthotopic liver transplantation in our center during October 2000 to December 2004. Data were collected and the 1-year and 3-year survival rates, were evaluated by Kaplan-Meier method. Based on the Pittsburg Scoring System, all cases were divided into 4 groups. The length of survival of each group was observed respectively, and differences were compared with Log-rank test. Results 3-year survival rate and tumor-free rate of all 46 patients were 46.7% and 38.8%, respectively. The mean tumor-free time was 27.7 months, and the mean survival time was 32.5 months. Among the 4 groups, no death or tumor relapse was detected in cases of grade 1 and grade 2 (group I) up to the present, whereas the 1-year tumor-free rate of grade 5(group IV) patients was only 12.5%, and no patient survived over 2 years. The 1-year and 3-year tumor-free rate among grade 3 and 4 (group II and III) patients were both about 65% and 40%, the mean tumor free time was about 32.5 and 24.3 months respectively, and there was no significant difference between 2 groups. In these two groups, the longest tumor free time was 58 months. Conclusions Some of the patients with advanced hepatocellular carcinoma still have the chance to survive tumor-free for a long time after liver transplantation. Pittsburg scoring system has more predictability than Milan criteria, especially in cases of grade 1, 2 and 5, but not so satisfactory in cases of grade 3 and 4.