肝移植后肝细胞癌复发的相关因素——一项巴西多中心研究
Factors Related to Hepatocellular Carcinoma Recurrence After Liver Transplantation-A Brazilian Multicenter Study.
作者信息
Bina Possatto M, de Ataíde E C, Fazzio Escanhoela C A, Sevá-Pereira T, de Cassia Martins Alves da Silva R, Felicio H, de Navarro Amado L R, Ferreira da Silva R, Soares Lima A, Boin I F S F
机构信息
Unit of Liver Transplantation, Clinical Hospital, State University of Campinas, Campinas, Brazil.
Liver Transplantation, Faculty of Medicine São Jose do Rio Preto, Rio Preto, Brazil.
出版信息
Transplant Proc. 2017 May;49(4):863-866. doi: 10.1016/j.transproceed.2017.01.055.
BACKGROUND
Liver transplantation (LT) is a curative treatment option for hepatocellular carcinoma (HCC); recurrent HCC after liver transplantation (HCC-R) is diagnosed in 9%-16%. The objective of this study was to evaluate which factors are associated with R-HCC after liver transplantation.
METHODS
This retrospective real-life study analyzed 278 LTs from 3 reference centers (2,093 LTs) in Brazil from 1988 to 2015. HCC-R with histologic confirmation was seen in 40 patients (14.4%).
RESULTS
Most of them were male with cirrhosis secondary to viral hepatitis. Only 37.5% underwent chemoembolization, and 50% had cold ischemia time >8 hours. From the explant analysis, most of the patients were outside Milan criteria and 37.5% had microvascular invasion. The donors were mostly male, and the median intensive care unit time was >3 days. The Kaplan-Meier survival was lower according to alpha-fetoprotein (AFP) >200 ng/dL (P = .02), and older donors and more blood transfusions were risk factors for HCC-R death.
CONCLUSION
AFP >200 ng/mL was associated with lower survival, and older donors and more blood transfusions were risk factors for death after HCC-R. A trend to lower survival was observed in patients who did not have chemoembolization and had cold ischemia times >8 hours.
背景
肝移植（LT）是肝细胞癌（HCC）的一种治愈性治疗选择；肝移植后复发性肝癌（HCC-R）的诊断率为9%-16%。本研究的目的是评估哪些因素与肝移植后复发性肝癌相关。
方法
这项回顾性现实研究分析了1988年至2015年巴西3个参考中心（共2093例肝移植）的278例肝移植病例。40例患者（14.4%）经组织学证实为HCC-R。
结果
他们大多数为男性，患有病毒性肝炎继发的肝硬化。仅37.5%的患者接受了化疗栓塞，50%的患者冷缺血时间>8小时。从切除标本分析来看，大多数患者不符合米兰标准，37.5%的患者有微血管侵犯。供者大多为男性，重症监护病房的中位时间>3天。根据甲胎蛋白（AFP）>200 ng/dL，卡普兰-迈耶生存率较低（P = 0.02），供者年龄较大和输血较多是HCC-R死亡的危险因素。
结论
AFP>200 ng/mL与较低的生存率相关，供者年龄较大和输血较多是HCC-R后死亡的危险因素。未接受化疗栓塞且冷缺血时间>8小时的患者生存率有降低趋势。
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