中国肝细胞癌患者肝移植后的预后指标
Indicators of prognosis after liver transplantation in Chinese hepatocellular carcinoma patients.
作者信息
Li Jin, Yan Lu-Nan, Yang Jian, Chen Zhe-Yu, Li Bo, Zeng Yong, Wen Tian-Fu, Zhao Ji-Chun, Wang Wen-Tao, Yang Jia-Yin, Xu Ming-Qing, Ma Yu-Kui
机构信息
Division of Liver Transplantation, West China Hospital, West China Medical School of Sichuan University, Chengdu 610041, Sichuan Province, China.
出版信息
World J Gastroenterol. 2009 Sep 7;15(33):4170-6. doi: 10.3748/wjg.15.4170.
AIM
To identify prognostic factors of patients with hepatocellular carcinoma (HCC), who were treated by orthotopic liver transplantation (OLT).
METHODS
From January 2000 to October 2006, 165 patients with HCC underwent OLT. Various clinicopathological risk factors for actuarial and recurrence-free survival were identified using the Kaplan-Meier method with the log-rank test. The Cox proportional hazards model was used to identify independently predictive factors for actuarial and recurrence-free survival, which were used to propose new selection criteria. We compared the outcome of the subgroup patients meeting different criteria. Survival analysis was performed using the Kaplan-Meier method with the log-rank test.
RESULTS
The median follow-up was 13.0 mo (2.8-69.5 mo). Overall, 1-, 2-, 3- and 5-year actuarial survival was 73.3%, 45.6%, 35.4% and 32.1%, respectively. One-, 2-, 3- and 5-year overall recurrence-free survival was 67.0%, 44.3%, 34.5% and 34.5%, respectively. In univariate analysis, number of tumors, total tumor size, lobar distribution, differentiation, macrovascular invasion, microvascular invasion, capsulation of the tumor, and lymph node metastasis were found to be associated significantly with actuarial and tumor-free survival. By means of using the multivariate Cox proportional hazards model, total tumor size and macrovascular invasion were found to be independent predictors of actuarial and tumor-free survival. When the selection criteria were expanded into the proposed criteria, there was no significant difference in 1-, 2-, 3- and 5-year actuarial and tumor-free survival of the 49 patients who met the proposed criteria (97.6%, 82.8%, 82.8% and 82.8%, and 90.7%, 82.8%, 68.8% and 68.8%, respectively) compared with that of patients who met the Milan or University of California, San Francisco (UCSF) criteria.
CONCLUSION
Macrovascular invasion and total tumor diameter are the strongest prognostic factors. The proposed criteria do not adversely affect the outcome of liver transplantation for HCC, compared with the Milan or UCSF criteria.
目的
确定接受原位肝移植（OLT）治疗的肝细胞癌（HCC）患者的预后因素。
方法
2000年1月至2006年10月，165例HCC患者接受了OLT。采用Kaplan-Meier法和对数秩检验确定精算生存率和无复发生存率的各种临床病理危险因素。使用Cox比例风险模型确定精算生存率和无复发生存率的独立预测因素，用于提出新的选择标准。我们比较了符合不同标准的亚组患者的结局。采用Kaplan-Meier法和对数秩检验进行生存分析。
结果
中位随访时间为13.0个月（2.8 - 69.5个月）。总体而言，1年、2年、3年和5年的精算生存率分别为73.3%、45.6%、35.4%和32.1%。1年、2年、3年和5年的总体无复发生存率分别为67.0%、44.3%、34.5%和34.5%。单因素分析中，肿瘤数量、肿瘤总大小、叶分布、分化程度、大血管侵犯、微血管侵犯、肿瘤包膜和淋巴结转移与精算生存率和无瘤生存率显著相关。通过多变量Cox比例风险模型，发现肿瘤总大小和大血管侵犯是精算生存率和无瘤生存率 的独立预测因素。当选择标准扩展为提议的标准时，符合提议标准的49例患者的1年、2年、3年和5年精算生存率和无瘤生存率（分别为97.6%、82.8%、82.8%和82.8%，以及90.7%、82.8%、68.8%和68.8%）与符合米兰标准或加利福尼亚大学旧金山分校（UCSF）标准的患者相比，无显著差异。
结论
大血管侵犯和肿瘤总直径是最强的预后因素。与米兰标准或UCSF标准相比，提议的标准对HCC肝移植的结局没有不利影响。
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