肝癌肝移植术后肝癌复发转移的特点及危险因素  

The characteristics and risk factors of tumor recurrence and metastasis in patients of hepatocellular carcinoma after liver transplantation

作　　者：吕波[1] 张宇[2] 廖志学[2] 冉顺[2] 梁冠林[2] 文天夫[2] 

机构地区：[1]成都铁路中心医院普外科,四川成都610081 [2]四川大学华西医院普外科,四川成都610041

出　　处：《四川医学》2010年第5期603-605,共3页Sichuan Medical Journal

摘　　要：目的探讨肝癌肝移植术后肿瘤复发转移的特点,包括复发部位、复发时间和危险因素。方法收集2005年1月1日~2006年12月31日肝癌肝移植连续患者99例术前、术中、术后资料,排除住院期死亡7例,定期随访,非肿瘤复发死亡5例、失访1例,余86例随访12~35个月,复发转移38例,与未复发组对照,总结复发转移危险因素,采用SPSS统计软件进行统计学分析。结果复发组较未复发组肿瘤数目多、最大肿瘤直径大。术前AFP水平〉400ng/ml、超出米兰标准、TNM分期Ⅲ~Ⅳ期、血管侵犯是肿瘤复发的危险因素。多因素分析显示TNM分期Ⅲ~Ⅳ期是肝移植术后肿瘤复发的独立危险因素。肿瘤血管侵犯是短期内肿瘤复发的危险因素。结论肝癌肝移植术后肿瘤首先复发转移部位较多见于肝外,大肝癌分期差、多伴血管侵犯,复发时间较短。肿瘤TNM分期Ⅲ~Ⅳ期是肿瘤复发的主要危险因素。肿瘤血管侵犯易使肿瘤短期复发。Objective To explore the characteristics of tumor recurrence and metastasis in patients of hepatocellular carcinoma（HCC） after liver transplantation（LT）,including sites,time and risk factors of recurrence.Methods Preoperative,intraoperative and postoperative data of consecutive 99 cases of HCC received LT were collected from January 1,2005 to December 31,2006.Seven cases of death were excluded in period of hospitalization.Then regular follow-up were performed,another 6 cases were excluded including 5 cases dead of no recurrence and 1 case dropped off without recurrence.The remnant 86 cases were followed up for 12 to 35 months.Tumor recurred and metastasis in 38 cases.Risk factors were analyzed using SPSS statistic software between recurrent group and no-recurrent group.Results The number of tumor were more and the largest tumor size were bigger in recurrence group than that in no-recurrence group.Preoperative level of alpha-fetoprotein（AFP）400ng/ml,exceeding Milan-criteria,pTNM staging being pT3 or pT4,and vascular invasion were risk factors for tumor recurrence.Multivariate analysis demonstrated that pTNM staging being pT3 or pT4 was independent risk factor for tumor recurrence after LT.The vascular invasion was risk factor for tumor recurrence after LT in short period.Conclusion Tumorrecurrence and metastasis occurred more outside the liver at first after LT.Large HCC had characteristics of understaging and vascular invasion,and they recurred early.The pTNM staging being pT3 or pT4 were major risk factors for tumor recurrence.Vascular invasion resulted in tumor recurrence in short period.

关 键 词：肝细胞癌 肝移植 肿瘤复发 无瘤生存 危险因素 

分 类 号：R735.7[医药卫生—肿瘤]