影响肝移植治疗肝细胞癌预后的相关因素分析  

Prognostic relevant fators of liver transplantation in adults with hepatocellular carcinoma： a retrospectiveanalysis

作　　者：谭永法[1] 阚和平[1] 谭凯[1] 付文广[1] 陈剑尉[1] 王恺[1] 周杰[1] 

机构地区：[1]南方医科大学附属南方医院肝胆外科 ,广州510515

出　　处：《中华器官移植杂志》2012年第6期354-357,共4页Chinese Journal of Organ Transplantation

摘　　要：目的探讨影响肝移植治疗肝细胞癌（HCC）预后的相关因素。方法回顾性分析2004年8月至2011年2月问147例HCC患者接受肝移植治疗的临床资料。单因素分析共纳入14个指标：受者性别、年龄、血型、术前肝功能分级、终末期肝病模型评分、甲胎蛋白（AFP）水平、肿瘤数目、肝脏被肿瘤取代率、是否侵犯左右叶、累计肿瘤直径、是否侵犯肝包膜、大血管受侵犯、微血管受侵犯（MVI）以及HCC组织学分级。将差异有统计学意义的指标纳入Cox风险比例模型行多因素分析，筛选出独立危险因素。结果143例受者获得完整随访，随访时间6-84个月，术后1、3年总体存活率分别为75．2％和54．7％，无瘤存活率分别为70％和59％。单因素分析显示，受者年龄、AFP水平、肿瘤数目、累计肿瘤直径、肝脏被肿瘤取代率、侵犯左右叶、侵犯肝包膜、大血管受侵犯、MVI等指标的差异有统计学意义（P〈0．05）；经多因素分析，MVI、大血管受侵犯和AFP≥400“g／L是影响HCC患者肝移植术后存活率的独立危险因素。结论MVI、大血管受侵犯、AFP是影响HCC肝移植术后存活率的主要危险因素，肝移植术前对其进行适当干预，术中严格按照无瘤技术操作，可明显改善预后。Objective To investigate the prognostic relevant factors of hepatocellular carcinoma （HCC） in recipients following liver transplantation （LT）. Methods The clinical data of 147 cases of HCC undergoing LT between Aug. 2004 and Feb. 2011 in Nanfang Hospital were studied retrospectively. Those of significance in 14 relevant factors involving gender, age, blood-type, CTP, model of end-stage liver disease （MELD）, alpha-fetoprotein （AFP）, tumor number, cumulative diameter of tumor, tumor occupying proportion of the liver, bilobar involvement, envelope invasion, macrovascular invasion, and microvascular invasion （MVI）, HCC histology differentiation, which were based on univariate analysis with Log-Rank, were analyzed by means of Multivariate Cox proportional hazard regression model to screen out independently relevant ones. Results 143 cases were followed up. The follow-up duration ranged from 6 to 84 months. The 1- and 3 year cumulative survival rate was 75.20% and 54. 70% respectively. The tumor-free 1- and 3-year cumulative survival rate was 70% and 59%respectively. Univariate ananlysis revealed that age, AFP, tumor number, cumulative diameter of tumor, tumor occupying proportion of the liver, bilobar involvement, envelope invasion, macrovascular invasion, and MVI had significant difference. In a Cox model, MVI, macrovascular invasion and AFP≥400μg/L were independent prognostic factors. Conclusion MVI, macrovascular invasion and AFP are the main prognostic risk fators. Intervention and non-tumor technique should be performed preoperatively and intraoperatively, respectively.

关 键 词：癌 肝细胞 肝移植 危险因素 

分 类 号：R735.7[医药卫生—肿瘤]