微血管侵犯对肝癌肝移植受者预后影响的临床研究  

Clinical study of microvascular invasion on prognosis of recipients after liver transplantation for liver cancer

作　　者：王建丰 曾凯宁[1] 李海波 邓宜南 张英才[1] 张彤[1] 易述红[1] 汪根树[1] 杨扬[1] 陈规划[1] Wang Jianfeng;Zeng Kaining;Li Haibo;Deng Yinan;Zhang Yingcai;Zhang Tong;Yi Shuhong;Wang Genshu;Yang Yang;Chen Guihua(Department of Hepatic Surgery,Liver Transplantation Center,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院肝脏外科暨肝移植中心,广州510630

出　　处：《器官移植》2021年第3期309-316,共8页Organ Transplantation

基　　金：国家“十三五”重大科技专项(2017ZX10203205-006-001);国家重点研发计划项目(2017YFA0104304);国家自然科学基金(81972286);广东省自然科学基金(2015A030312013);广东省科技项目(20169013);广州市科技项目(201508020262)。

摘　　要：目的探讨微血管侵犯(MVI)对原发性肝癌(肝癌)肝移植受者预后的影响。方法回顾性分析177例肝癌肝移植受者的临床资料,根据术后病理学检查结果分为MVI阳性组(64例)和MVI阴性组(113例)。比较MVI阴性组和MVI阳性组受者的临床资料;分析肝癌肝移植受者的预后及危险因素。结果177例受者中,64例(36.2%)MVI阳性,113例(63.8%)MVI阴性。与MVI阴性受者相比,MVI阳性受者的肿瘤分化程度低、术前甲胎蛋白(AFP)水平高、肿瘤最大直径大、肿瘤数量多、伴卫星灶多、不符合米兰标准的例数多(均为P<0.05)。肝癌肝移植受者1、3、5年累积生存率(OS)和无复发生存率(RFS)分别为80.2%、62.1%、58.5%和66.3%、57.5%、51.2%。MVI阳性受者的1、3、5年OS和RFS分别为70%、39%、35%和53%、39%、33%,低于MVI阴性受者的86%、75%、72%和73%、68%、63%,差异均有统计学意义(均为P<0.05)。Cox回归分析结果显示,肿瘤最大直径>8 cm、术前AFP水平≥20 ng/mL、肿瘤中低分化和MVI阳性是影响肝癌肝移植受者OS的独立危险因素(均为P<0.05),MVI阳性、肿瘤中低分化以及术前未降期成功是影响肝癌肝移植受者RFS的独立危险因素(均为P<0.05)。结论MVI对预测肝癌肝移植受者的预后具有重要的临床价值。Objective To evaluate the effect of microvascular invasion(MVI)on prognosis of recipients after liver transplantation for primary liver cancer(liver cancer).Methods Clinical data of 177 recipients after liver transplantation for liver cancer were retrospectively analyzed.All patients were divided into the MVI-positive group(n=64)and MVI-negative group(n=113)according to postoperative pathological examination results.Clinical data were statistically compared of all recipients between the negative and positive MVI groups.The prognosis and risk factors of liver transplantation recipients for liver cancer were analyzed.Results Among 177 recipients,64 cases(36.2%)were positive for MVI and 113(63.8%)negative for MVI.Compared with the MVI-negative recipients,MVI-positive recipients had significantly lower degree of tumor differentiation,higher preoperative alpha-fetaprotein(AFP)level,larger maximal tumor diameter,a larger quantity of tumors,more satellite lesions and more recipients who did not meet the Milan criteria(all P<0.05).The 1-,3-and 5-year overall survival(OS)and recurrence-free survival(RFS)of recipients after liver transplantation for liver cancer were 80.2%,62.1%,58.5%and 66.3%,57.5%,51.2%,respectively.The 1-,3-and 5-year OS and RFS of MVI-positive recipients were 70%,39%,35%and 53%,39%,33%,significantly lower than 86%,75%,72%and 73%,68%,63%of their counterparts negative for MVI(all P<0.05).Cox regression analysis showed that the maximal tumor diameter>8 cm,preoperative AFP level≥20 ng/mL,low degree of tumor differentiation and positive MVI were the independent risk factors for OS of recipients after liver transplantation for liver cancer(all P<0.05).Positive MVI,low degree of tumor differentiation and preoperative down-staging failure were the independent risk factors for RFS of recipients after liver transplantation for liver cancer(all P<0.05).Conclusions MVI is of significant clinical value in predicting clinical prognosis of recipients after liver transplantation for liver cancer.

关 键 词：原发性肝癌 肝移植 微血管侵犯(MVI) 累积生存率(OS) 无复发生存率(RFS) 甲胎蛋白 米兰标准 降期治疗 

分 类 号：R617[医药卫生—外科学] R735.7[医药卫生—临床医学]