补救性肝移植、再次肝切除和局部消融治疗肝癌术后复发的临床疗效及其预后危险因素  

Clinical efficacy and prognostic risk factors of salvage liver transplantation, rehepatectomy, and local ablation in the treatment of postoperative recurrence of hepatocellular carcinoma

作　　者：林鹏 游悦楷 刘建勇 杨芳[2] 蔡秋程[2] 江艺[2] 沈佳佳 Lin Peng;You Yuekai;Liu Jianyong;Yang Fang;Cai Qiucheng;Jiang Yi;Shen Jiajia(Fuzhou Clinical Medical College of Fujian Medical University,900th Hospital of the Joint Logistics Team,PLA,Fuzhou 350025,China;Department of Hepatobiliary Surgery,900th Hospital of the Joint Logistics Team,PLA,Fuzhou 350025,China)

机构地区：[1]福建医科大学福总临床医学院(中国人民解放军联勤保障部队第九○○医院),福州350025 [2]中国人民解放军联勤保障部队第九○○医院肝胆外科,福州350025

出　　处：《中华肝脏病杂志》2023年第2期155-160,共6页Chinese Journal of Hepatology

基　　金：福建省自然科学基金(2020Y0078)。

摘　　要：目的探讨肝癌术后复发患者补救性肝移植(SLT)、再次肝切除(RH)和局部消融(LA)治疗的临床疗效,并分析影响肝癌复发患者预后的危险因素。方法回顾性收集2005年1月至2018年6月在解放军联勤保障部队第九○○医院145例肝癌复发患者的临床资料,其中SLT组25例,RH组44例,LA组76例。随访并统计3组患者术后1、2和3年总体生存率、无复发生存率和并发症。采用单因素及多因素COX分析影响肝癌复发患者预后的危险因素。结果当肝癌复发符合米兰标准时,SLT组、RH组和LA组术后1、2、3年总体生存率分别为100.0%、84.0%、72.0%,95.5%、77.3%、65.9%和90.8%、76.3%、63.2%。SLT和RH比较(P=0.303)、RH和LA比较(P=0.152),总体生存率差异均无统计学意义。SLT和RH比较、RH和LA比较,无复发生存率差异均有统计学意义(均P=0.046)。SLT和RH比较、RH和LA比较,并发症发生率差异均无统计学意义(均P>0.017)。年龄>65岁是影响肝癌复发患者总体生存率的独立危险因素。年龄>65岁及复发时间<24个月是影响肝癌复发患者无复发生存率的独立危险因素。结论当肝癌复发符合米兰标准时,SLT是最佳的治疗方案,在肝源紧缺的情况下,RH和LA是复发性肝癌合适的治疗方案。Objective To investigate and analyze the clinical efficacy of salvage liver transplantation(SLT),rehepatectomy(RH),local ablation(LA),and prognostic risk factors in patients with postoperative recurrence of hepatocellular carcinoma.Methods Clinical data of 145 patients with recurrent liver cancer in the 900th Hospital of the Joint Logistics Support Force of the People's Liberation Army from January 2005 to June 2018 were retrospectively collected.SLT group,RH group,and LA group included 25,44,and 76 cases,respectively.Follow-up and statistics were recorded on the overall survival rate,relapse-free survival rate,and complications of the three groups of patients at 1,2,and 3 years after surgery.Univariate and multivariate COX analyses were used to analyze the prognostic risk factors in patients with recurrent HCC.Results The overall survival rates of 1,2,and 3 years following surgery in the SLT,RH,and LA groups were 100.0%,84.0%,72.0%,95.5%,77.3%,65.9%,90.8%,76.3%,and 63.2%,respectively,when the recurrence of liver cancer met the Milan criteria.The overall survival rate did not differ statistically between SLT and RH(P=0.303)or between RH and LA(P=0.152).There were statistically significant differences in recurrence-free survival between SLT and RH or RH and LA(P=0.046).There was no statistically significant difference in the incidence of complications between SLT and RH or RH and LA(P>0.017).Age>65 years was an independent risk factor affecting the overall survival rate in patients with recurrent HCC.Age>65 years and recurrence time<24 months were independent risk factors affecting the recurrence-free survival rate in patients with recurrent HCC.Conclusion SLT is the best treatment option when the recurrence of HCC meets Milan's criteria.RH and LA are the appropriate treatment plans for recurrent HCC when the liver source is limited.

关 键 词：肝细胞癌 补救性肝移植 再次肝切除 局部消融 复发 危险因素 

分 类 号：R735.7[医药卫生—肿瘤]