首次肝癌切除时不符合米兰标准影响补救性肝移植预后  

First hepatectomy beyond the Milan criteria affects the prognosis of salvage liver transplantation

作　　者：叶莹鹏 杨勇[1] 朱宏达 冯斐 吴胜东 陆才德[1] 房炯泽 Ye Yingpeng;Yang Yong;Zhu Hongda;Feng Fei;Wu Shengdong;Lu Caide;Fang Jiongze(Department of Hepatopancreatobiliary Surgery,Ningbo Medical Centre Lihuili Hospital,Ningbo University,Ningbo 315041,China)

机构地区：[1]宁波大学附属李惠利医院肝胆胰外科,宁波315041

出　　处：《中华肝胆外科杂志》2023年第11期813-819,共7页Chinese Journal of Hepatobiliary Surgery

基　　金：宁波市医疗卫生品牌学科(PPXK2018-03);浙江省医药卫生科技计划项目(2020KY865);宁波市公益类科技计划项目(2021S184)。

摘　　要：目的分析影响补救性肝移植(SLT)患者预后的因素。方法回顾性分析宁波大学附属李惠利医院2012年1月至2022年5月97例肝癌肝移植患者的临床资料,其中男性84例,女性13例,年龄(53.6±7.4)岁,包括33例一期肝移植患者(PLT)和64例SLT患者。SLT患者根据其首次肝切除是否符合米兰标准分为符合米兰标准组(35例,SLT-A组)和不符合米兰标准组(29例,SLT-B组)。分析三组间临床病理特点、预后差异和SLT影响因素。结果PLT、SLT-A和SLT-B三组相比较,肿瘤数量(χ^(2)=16.03,P<0.001)、微血管侵犯(MVI)(χ^(2)=10.97,P=0.004)、移植后复发(χ^(2)=9.31,P=0.010)、无复发生存时间(RFS)(F=14.05,P=0.001)和总生存时间(OS)(F=17.27,P<0.001)差异有统计学意义。PLT组患者的RFS(P=0.047)与OS(P=0.012)均优于SLT-B组,SLT-A组患者的RFS(P=0.007)与OS(P=0.024)也均优于SLT-B组,差异均有统计学意义。多因素分析显示,首次肝切除时不符合米兰标准是SLT患者RFS(HR=4.378,95%CI:1.393~13.756,P=0.011)和OS(HR=5.391,95%CI:1.428~20.352,P=0.013)的独立危险因素,MVI阳性是SLT患者RFS(HR=4.042,95%CI:1.137~14.368,P=0.031)的独立危险因素。结论首次肝切除时不符合米兰标准以及MVI阳性的患者行SLT后预后仍较差,米兰标准是否能和PLT一样成为SLT的金标准还有待进一步研究。Objective To analyze the prognostic factors affecting salvage liver transplantation(SLT).Methods The clinical data of 97 patients undergoing liver transplantation in the Ningbo Medical Centre Lihuili Hospital from January 2012 to May 2022 were retrospectively analyzed,including 84 males and 13 females,aged(53.6±7.4)years.Among them,33 patients underwent primary liver transplantation(PLT)and 64 underwent SLT.SLT patients were subdivided into the groups within the Milan criteria(SLT-A,n=35)and beyond the Milan criteria(SLT-B,n=29),according to whether the Milan criteria were met at first hepatectomy.Clinicopathological and prognostic data were subsequently analyzed.Results The tumor number(χ^(2)=16.03,P<0.001),microvascular invasion(MVI)(χ^(2)=10.97,P=0.004),recurrence rate(χ^(2)=9.31,P=0.010),recurrence-free survival(RFS,F=14.05,P=0.001)and overall survival(OS,F=17.27,P<0.001)were significantly different among the three groups.RFS(P=0.047)and OS(P=0.012)in PLT group were better than those in SLT-B group.RFS(P=0.007)and OS(P=0.024)in SLT-A group were also better than those in SLT-B group.The multivariate analysis indicated that beyond the Milan criteria at first hepatectomy was an independent risk factor for RFS(HR=4.378,95%CI:1.393-13.756,P=0.011)and OS(HR=5.391,95%CI:1.428-20.352,P=0.013)in patients undergoing SLT,and MVI positive(HR=4.042,95%CI:1.137-14.368,P=0.031)was an independent risk factor for RFS in patients undergoing SLT.Conclusion Patients beyond the Milan criteria at first hepatectomy and MVI positive showed a poorer prognosis after SLT.Whether the Milan criteria should be the gold standard for SLT as well as for PLT needs further study.

关 键 词：癌 肝细胞 米兰标准 补救性肝移植 

分 类 号：R735.7[医药卫生—肿瘤]