肝癌术后复发补救性肝移植疗效及预后影响因素  

Clinical efficacy and prognostic factors of salvage liver transplantation for postoperative recurrence of primary liver cancer

作　　者：陈拓 张全保[1] 陶一峰[1] 沈丛欢[1] 李瑞东[1] 马震宇[1] 李建华[1] 陆录[1] 陈进宏[1] 钦伦秀[1] 王正昕[1] Chen Tuo;Zhang Quanbao;Tao Yifeng;Shen Conghuan;Li Ruidong;Ma Zhenyu;Li Jianhua;Lu Lu;Chen Jinhong;Qin Lunxiu;Wang Zhengxin(Department of General Surgery,Huashan Hospital Affiliated to Fudan University,Institute of Organ Transplantation,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院普通外科复旦大学器官移植研究所,上海200040

出　　处：《中华肝脏外科手术学电子杂志》2021年第4期365-370,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家科技重大专项(2017ZX10203205);国家自然科学基金面上项目(81773089,81873874);上海申康医院发展中心临床三年行动计划(SHDC2020CR2021B)。

摘　　要：目的探讨原发性肝癌(肝癌)术后复发补救性肝移植(SLT)疗效及预后影响因素。方法回顾性分析2014年5月至2019年10月在复旦大学附属华山医院行肝移植的273例肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男252例,女21例;平均年龄(51±9)岁。根据术式不同分组,行初始肝移植(PLT)196例(PLT组),肝癌根治性切除后复发行SLT 77例(SLT组)。比较两组围手术期和并发症发生情况。生存分析采用Kaplan-Meier法和Log-rank检验。采用Cox比例风险回归模型分析SLT患者术后预后的独立影响因素。结果患者一般资料按1∶1倾向性评分匹配后,两组各70例。SLT组手术时间(479±106)min,明显长于PLT组的(438±79)min(t=2.587,P<0.05);SLT组和PLT组围手术期死亡率分别为11%(8/70)、6%(4/70),差异无统计学意义(χ^(2)=1.458,P>0.05)。SLT组术后1、3、5年总体生存率分别为85.7%、75.0%、63.3%,PLT组相应为88.3%、79.0%、70.3%;SLT组术后1、3、5年无瘤生存率分别为98.4%、72.2%、57.1%,PLT组相应为92.5%、74.3%、54.7%;两组总体生存和无瘤生存差异无统计学意义(χ^(2)=1.627,0.265;P>0.05)。多因素分析显示,AFP>200μg/L和肿瘤最大径>3 cm是SLT患者术后总体生存的独立危险因素(HR=2.630,3.082;P<0.05),亦是术后无瘤生存的独立危险因素(HR=5.965,3.166;P<0.05)。结论SLT是肝癌术后复发的一种安全可靠治疗手段,可获得与PLT相似的治疗效果。AFP和肿瘤直径为SLT患者术后预后的独立影响因素。Objective To evaluate the clinical efficacy and to explore the prognostic factors of salvage liver transplantation(SLT)for postoperative recurrence of primary liver cancer.Methods Clinical data of 273 patients with primary liver cancer who underwent liver transplantation in Huashan Hospital Affiliated to Fudan University from May 2014 to October 2019 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,252 patients were male and 21 female,aged(51±9)years on average.According to different surgical methods,196 patients undergoing primary liver transplantation were assigned into the PLT group and 77 patients receiving SLT due to postoperative recurrence after radical resection were allocated into the SLT group.The perioperative conditions and incidence of complications were statistically compared between two groups.Survival analysis was performed by Kaplan-Meier method and Log-rank test.The independent influencing factors of postoperative prognosis of SLT patients were analyzed by Cox proportional hazards regression model.Results After propensity score matching of baseline data at a ratio of 1:1,70 patients were assigned into each group.In the SLT group,the operation time was(479±106)min,significantly longer than(438±79)min in the PLT group(t=2.587,P<0.05).The perioperative mortality rate in the SLT group was 11%(8/70),which did not significantly differ from 6%(4/70)in the PLT group(χ^(2)=1.458,P>0.05).The 1-,3-,5-year overall survival rates were 85.7%,75.0%,63.3%in the SLT group and were 88.3%,79.0%,70.3%in the PLT group,respectively.The 1-,3-,5-year tumor-free survival rates were 98.4%,72.2%,57.1%in the SLT group,and were 92.5%,74.3%,54.7%in the PLT group,respectively.The overall survival and tumor-free survival rates did not significantly differ between two groups(χ^(2)=1.627,0.265;P>0.05).Multivariate analysis demonstrated that AFP>200μg/L and the maximal tumor diameter>3 cm were the independent risk factors for p

关 键 词：肝肿瘤 肝移植 治疗结果 危险因素 

分 类 号：R735.7[医药卫生—肿瘤]