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目的分析影响肝细胞癌(HCC)患者肝移植后肿瘤复发和预后的相关因素,总结HCC患者肝移植的选择标准。方法回顾性分析118例HCC肝移植受者的临床资料,应用单因素和多因素的分析方法,分析临床和病理等相关因素对HCC患者肝移植后肿瘤复发及预后的影响,筛选出影响肿瘤复发和预后的危险因素,并结合国际HCC肝移植受者选择标准运用于临床。结果HCC患者肝移植围手术期死亡8例,对存活的110例随访1～32个月,其中有41例肿瘤复发(37.3 %),死亡39例(35.5%);12、18和24个月的累积存活率分别是84.55%、70.30%和62.24%;12、18和24个月的无瘤存活率分别是69.05%、66.93%和61.38%。单因素分析结果显示癌栓形成、米兰标准、肿瘤大小、肿瘤分化程度以及pTNM分期对HCC患者肝移植后肿瘤复发有显著影响;癌栓形成、米兰标准、术前血清甲胎蛋白(AFP)水平、肿瘤分化程度以及pTNM分期对患者预后有显著影响;多因素分析显示,癌栓形成和肿瘤分化程度是肿瘤复发的独立影响因素,癌栓形成和术前AFP水平则是影响预后的独立危险因素。结论癌栓形成和肿瘤分化程度是影响HCC患者肝移植后肿瘤复发的独立因素,而癌栓形成和术前AFP水平是影响预后的独立危险因素。
Objective To analyze the related factors of tumor recurrence and prognosis in patients with hepatocellular carcinoma (HCC) after liver transplantation and summarize the selection criteria of liver transplantation in patients with HCC. Methods A retrospective analysis of 118 cases of HCC liver transplant recipients clinical data, the application of univariate and multivariate analysis of clinical and pathological factors related to HCC patients after liver transplantation tumor recurrence and prognosis, screening out the impact of tumor recurrence And prognostic risk factors, combined with the international HCC criteria for the selection of liver transplant patients for clinical use. Results Perioperative deaths occurred in 8 patients with HCC and in 110 patients survived 1 to 32 months after liver transplantation. Among them, 41 (37.3%) were tumor recurrences and 39 (35.5%) were deaths; 12, 18 and 24 months The cumulative survival rates were 84.55%, 70.30% and 62.24% respectively. The tumor-free survival rates at 12, 18 and 24 months were 69.05%, 66.93% and 61.38%, respectively. Univariate analysis showed that tumor thrombus formation, Milan criteria, tumor size, tumor differentiation and pTNM stage had a significant effect on tumor recurrence after liver transplantation in HCC patients. Thrombosis, Milan criteria, preoperative serum alpha-fetoprotein (AFP) level , Tumor differentiation and pTNM stage had a significant effect on the prognosis of patients. Multivariate analysis showed that the formation of tumor thrombus and the degree of tumor differentiation were independent factors of tumor recurrence. Thrombosis and preoperative AFP levels were independent risk factors for prognosis . Conclusion The formation of tumor thrombus and the degree of tumor differentiation are the independent factors that affect the recurrence of tumor in HCC patients after liver transplantation. However, the formation of tumor thrombus and preoperative AFP levels are independent risk factors for prognosis.