1 Division of Transplant and Hepatobiliary Surgery, Henry Ford Transplant Institute, Henry Ford Hospital, Detroit, Michigan. 2 Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan. 3 Address correspondence to: Atsushi Yoshida, M.D., F.A.C.S., 2799 W. Grand Blvd. CFP-2, Detroit, MI 48202.
Transplantation. 2014 Mar 27;97(6):694-701. doi: 10.1097/01.TP.0000437426.15890.1d.
Absolute lymphocyte count (ALC) is considered a surrogate marker for the level of immunosuppression and nutritional status of patients and a prognostic factor for survival and recurrence in several cancers. The aim of this study was to investigate the prognostic value of peritransplant ALC for the recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT).
HCC patients who underwent LT between 2000 and 2010 were evaluated. Exclusion criteria were combined HCC and cholangiocarcinoma. Peritransplant ALCs (before LT and 2 weeks and 1 month after LT) were analyzed along with tumor, operative, and donor characteristics to identify risk factors for the recurrence of HCC.
HCC developed in 27 of the 173 LT patients investigated for risk factors (15.6%). The median time to recurrence was 1.14 years. Low ALCs before and after LT were associated with a higher recurrence rate in a continuous manner (before LT: hazard ratio=1.12, P=0.003; 2 weeks after LT: hazard ratio=1.14, P=0.008; 1 month after LT: hazard ratio=1.06, P=0.055) (increased risk per 100/μL down). On multivariate Cox regression analysis, peritransplant persistent lymphopenia (<1000/μL before LT and <500/μL at 2 weeks and 1 month after LT) was an independent risk factor for cancer recurrence (hazard ratio=7.05, P<0.001), along with tumor characteristics.
Peritransplant lymphopenia is a powerful prognostic factor for the recurrence of HCC after LT, which suggests that maintaining ALCs in LT patients might improve cancer outcome.
绝对淋巴细胞计数（ALC）被认为是患者免疫抑制水平和营养状况的替代标志物，也是几种癌症生存和复发的预后因素。本研究旨在探讨移植前 ALC 对肝癌（HCC）患者肝移植（LT）后复发的预测价值。
评估了 2000 年至 2010 年间接受 LT 的 HCC 患者。排除标准为合并 HCC 和胆管细胞癌。分析移植前（LT 前和 LT 后 2 周和 1 个月）的 ALC 以及肿瘤、手术和供体特征，以确定 HCC 复发的危险因素。
在调查危险因素的 173 例 LT 患者中，27 例发生 HCC（15.6%）。中位复发时间为 1.14 年。LT 前后低 ALC 与更高的复发率呈连续相关（LT 前：风险比=1.12，P=0.003；LT 后 2 周：风险比=1.14，P=0.008；LT 后 1 个月：风险比=1.06，P=0.055）（每增加 100/μL 风险增加）。多变量 Cox 回归分析显示，移植前后持续性淋巴细胞减少症（LT 前<1000/μL，LT 后 2 周和 1 个月时<500/μL）是 HCC 复发的独立危险因素（风险比=7.05，P<0.001），与肿瘤特征有关。
移植前后淋巴细胞减少症是 LT 后 HCC 复发的有力预后因素，提示维持 LT 患者的 ALC 可能改善癌症结局。
