Zhu Yang-Bo, Xu Xiao, Zheng Shu-Sen
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of medicine; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Health; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou 310003, China.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2014 Nov;43(6):658-63. doi: 10.3785/j.issn.1008-9292.2014.11.004.
To evaluate the risk factors for recurrence in patients with hepatocellular carcinoma (HCC) after liver transplantation (LT).
One hundred and fifteen small HCC patients, who met Milan criteria (single<5 cm or showing up to three nodules, each of them<3 cm without major vascular invasion or distant metastasis) and underwent LT in our hospital from January 2007 to November 2013, were enrolled in the study. The risk factors for recurrence were analyzed by Cox regression and the influence of the Milan criteria and microvascular invasion (MVI) on the disease-free survival (DFS) and recurrence of patients were assessed with survival analysis and ROC method.
Ninety-eight out of 115 small HCC patients were included for analysis, the 1-,3-, 5-year overall survival of patients was 91.8%, 80.6%, 79.6% and DFS was 87.8%, 74.5%, 73.5%, respectively. Survival analysis identified that MVI, macro-vascular invasion, exceeding the Milan criteria and pre-transplant down-staging treatment were related to tumor recurrence (P<0.05). Multivariate Cox regression analysis showed that MVI and exceeding the Milan criteria were two independent prognostic indicators for early recurrence of small HCC after LT. The 1-,3-,5-year DFS for 69 patients without MVI and 29 patients with MVI were 92.8%, 85.5%, 85.5% and 75.9%, 55.2%, 48.3%, respectively (P<0.01). The 1-,3-,5-year DFS for 84 patients meeting the Milan criteria and 14 exceeding the Milan criteria were 91.7%, 83.3%, 79.8% and 64.3%, 42.9%, 42.9%, respectively (P<0.01).
For early HCC patients undergoing LT, the presence of MVI would predict tumor recurrence and can be an indicator for the adjuvant treatment or other salvage treatments.
评估肝移植（LT）后肝细胞癌（HCC）患者复发的危险因素。
选取2007年1月至2013年11月在我院接受LT且符合米兰标准（单个肿瘤<5 cm或最多三个结节，每个结节<3 cm，无大血管侵犯或远处转移）的115例小肝癌患者纳入研究。采用Cox回归分析复发的危险因素，并用生存分析和ROC方法评估米兰标准及微血管侵犯（MVI）对患者无病生存期（DFS）和复发的影响。
115例小肝癌患者中98例纳入分析，患者1年、3年、5年总生存率分别为91.8%、80.6%、79.6%，DFS分别为87.8%、74.5%、73.5%。生存分析表明，MVI、大血管侵犯、超出米兰标准及移植前降期治疗与肿瘤复发相关（P<0.05）。多因素Cox回归分析显示，MVI和超出米兰标准是LT后小肝癌早期复发的两个独立预后指标。69例无MVI患者和29例有MVI患者的1年、3年、5年DFS分别为92.8%、85.5%、85.5%和75.9%、55.2%、48.3%（P<0.01）。84例符合米兰标准患者和14例超出米兰标准患者的1年、3年、5年DFS分别为91.7%、83.3%、79.8%和64.3%、42.9%、42.9%（P<0.01）。
对于接受LT的早期HCC患者，MVI的存在可预测肿瘤复发，可作为辅助治疗或其他挽救性治疗的指标。
