Briceño J, Ruiz J, Ciria R, Naranjo A, Sánchez-Hidalgo J, Luque A, Rufián S, de la Mata M, López-Cillero P
Liver Transplantation Unit, Hospital Reina Sofía, Cordoba, Spain.
Transplant Proc. 2008 Nov;40(9):2990-3. doi: 10.1016/j.transproceed.2008.09.022.
A better understanding of tumor factors influencing patient and graft survival and recurrence of hepatocellular carcinoma (HCC) associated with hepatitis C virus (HCV) cirrhosis may be useful to maximize the benefits of liver transplantation (OLT). Sixty-three adults underwent OLT for end-stage liver disease secondary to HCV with concomitant HCC. The outcome measures were patient and graft survival, as well as recurrence-free survival, computed using a stepwise Cox proportional hazards regression analysis. Kaplan-Meier 1-, 3-, and 5-year patient survival rates were 82%, 80%, and 69%, respectively, they were better for incidentally discovered HCC compared with preoperatively diagnosed HCC (P = .04). The overall recurrence-free survival rates were 81%, 76%, and 61% at 1, 3, and 5 years, respectively. Univariate analysis showed that nonincidental HCC (P = .04), pTNM stage (P = .012) and vascular invasion (P = .003) correlated with recipient mortality. Vascular invasion (odds ratio [OR] = 2.12; P = .001) and pTNM (OR = 1.50; P = .008) were independent predictors of overall survival. A combination of tumor vascular invasion with advanced pTNM was associated with a dismal prognosis (log-rank = 21.89; P = .0001). Tumor grading (OR = 1.2; P = .04), pTNM (OR = 3.7; P = .001) and vascular invasion (OR = 1.6; P = .002) were independent predictors of recurrence. In conclusion, advanced pTNM and the presence of vascular invasion are strong predictors of poor survival and tumor recurrence.
更好地了解影响丙型肝炎病毒（HCV）相关肝硬化患者的生存、移植物存活以及肝细胞癌（HCC）复发的肿瘤因素，可能有助于最大限度地提高肝移植（OLT）的益处。63名成人因HCV相关终末期肝病合并HCC接受了OLT。结局指标为患者和移植物存活情况以及无复发生存情况，通过逐步Cox比例风险回归分析进行计算。Kaplan-Meier法得出的1年、3年和5年患者生存率分别为82%、80%和69%，与术前诊断的HCC相比，偶然发现的HCC患者生存率更高（P = 0.04）。1年、3年和5年的总体无复发生存率分别为81%、76%和61%。单因素分析显示，非偶然发现的HCC（P = 0.04）、pTNM分期（P = 0.012）和血管侵犯（P = 0.003）与受者死亡率相关。血管侵犯（比值比[OR]=2.12；P = 0.001）和pTNM（OR = 1.50；P = 0.008）是总体生存的独立预测因素。肿瘤血管侵犯与晚期pTNM相结合与预后不良相关（对数秩检验=21.89；P = 0.0001）。肿瘤分级（OR = 1.2；P = 0.04）、pTNM（OR = 3.7；P = 0.001）和血管侵犯（OR = 1.6；P = 0.002）是复发的独立预测因素。总之，晚期pTNM和血管侵犯的存在是生存不良和肿瘤复发的有力预测因素。
