微血管侵犯对肝癌肝移植受者预后的影响:一项倾向性评分匹配研究  

Effect of Microvascular Invasion on the Prognosis of Liver Transplantation Recipients with Hepatocellular Carcinoma:A Propensity Score Matching Study

作　　者：岳嘉伟 杨洪吉 陈凯[2] 侯一夫 朱世凯[2] 梁田[2] 魏博文 Yue Jiawei;Yang Hongji;Chen Kai;Hou Yifu;Zhu Shikai;Liang Tian;Wei Bowen(Department of Hepatobiliary Surgery,Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China;Organ Transplantation Center,Sichuan Academy of Medical Sciences/Sichuan Provincial People's Hospital,Chengdu 610072,Sichuan,China)

机构地区：[1]西南医科大学附属医院肝胆外科,四川泸州646000 [2]电子科技大学附属医院/四川省人民医院器官移植中心,成都610072

出　　处：《肿瘤预防与治疗》2023年第9期772-777,共6页Journal of Cancer Control And Treatment

摘　　要：目的:基于倾向性评分匹配(propensity score matching,PSM)法,探讨微血管侵犯(microvascular infiltration,MVI)对肝细胞癌(hepatocellular carcinoma,HCC)肝移植受者预后的影响。方法:回顾性收集四川省人民医院2015年1月至2020年12月期间行肝移植术的112例HCC患者的临床病理资料,并根据术后病理诊断分为MVI阳性组(42例)和MVI阴性组(70例),对两组患者进行1∶1PSM,比较两组患者PSM前后临床病理特征的差异,采用Cox回归模型分析经PSM后MVI对HCC肝移植受者总生存期(overall survival,OS)和无复发生存期(relapse-free survival,RFS)的影响。结果:本研究共成功匹配40对HCC肝移植受者进行回顾性分析。PSM前,肝功能Child Pugh分级、术前甲胎蛋白、肿瘤大小(肿瘤最大直径)、肿瘤分化程度、是否符合米兰标准在两组间的差异具有统计学意义(均P<0.05);PSM后,各基线及临床资料在组间分布趋于一致,差异均无统计学意义(均P>0.05)。MVI阳性组与阴性组HCC肝移植受者的1、3、5年OS分别为69.5%、38.8%、34.9%和85.5%、74.7%、71.6%,差异有统计学意义(χ^(2)=11.608,P=0.003);MVI阳性组与阴性组HCC肝移植受者的1、3、5年RFS分别为52.8%、38.8%、32.7%和72.6%、67.7%、62.5%,差异有统计学意义(χ^(2)=9.442,P=0.009)。Cox回归分析结果显示:MVI阳性是影响HCC肝移植受者术后OS和RFS的独立危险因素(均P<0.05),HR值分别为1.747和1.713。结论:MVI阳性对HCC肝移植术后患者的预后有显著影响,是影响OS和RFS的独立危险因素。Objective:To explore the effect of microvascular invasion(MVI)on the prognosis of hepatocellular carcinoma(HCC)patients after liver transplantation based on the method of propensity score matching(PSM).Methods:The clinicopathological data of 112 HCC patients who underwent liver transplantation in Sichuan Provincial Peoples Hospital from January 2015 to December 2020 were retrospectively collected,and the patients were assigned to the MVI-positive group(42 cases)and the MVI-negative group(70 cases)according to postoperative pathological diagnosis.1∶1 PSM was performed on the two groups of patients,and the differences in clinicopathological characteristics before and after PSM were compared.Cox regression model was used to analyze the effect of MVI after PSM on overall survival(OS)and relapse-free survival(RFS)of HCC patients after liver transplantation.Results:A total of 80 HCC liver transplant recipients were successfully matched for retrospective analysis,40 for each group.Before PSM,there were statistically significant differences between the two groups in Child-Pugh classification,preoperative alpha-fetoprotein,tumor size(the largest diameter of tumor),tumor differentiation degree,and compliance with the Milan's criteria(all P<0.05);after PSM,baseline and clinical data among groups tended to be consistent,and the differences were not statistically significant(all P>0.05).The 1-,3-and 5-year OS of HCC liver transplant recipients in MVI-positive group and MVI-negative group were 69.5%,38.8%,34.9% and 85.5%,74.7%,71.6%,respectively,with statistically significant differences(χ^(2)=11.608,P=0.003).The 1-,3-and 5-year RFS of HCC liver transplantation recipients in MVI-positive group and MVI-negative group were 52.8%,38.8%,32.7% and 72.6%,67.7%,62.5%,respectively,with statistically significant difference(χ^(2)=9.442,P=0.009).Cox regression analysis showed that positive MVI was an independent risk factor for OS and RFS of HCC patients after liver transplantation(both P<0.05),with HR values of 1.747 and 1.713,respe

关 键 词：肝细胞癌 肝移植 微血管侵犯 预后 倾向性评分匹配法 

分 类 号：R735.7[医药卫生—肿瘤]