米兰标准以外的 HCC 患者肝移植与肝切除术的比较：倾向评分分析。

Transplantation versus hepatectomy for HCC beyond the Milan criteria: A propensity score analysis.

机构信息

Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Int J Surg. 2017 Aug;44:33-42. doi: 10.1016/j.ijsu.2017.05.034. Epub 2017 May 19.

DOI:10.1016/j.ijsu.2017.05.034

PMID:28529191

Abstract

BACKGROUND

Increasing studies have suggested that surgical resection (SR) or liver transplantation (LT) could bring survival benefits for patients with hepacelluar carcinoma (HCC) beyond Milan criteria. This study compared the long-term survival of patients beyond the Milan criteria who received SR or LT.

MATERIAL AND METHODS

A total of 461 HCC patients were retrospectively collected. Analysis was performed using propensity score matching (PSM), the Kaplan-Meier method and the Cox proportional hazards model.

RESULTS

Prognosis was significantly better for the LT group than the SR group before (P < 0.001) and after PSM(p = 0.003). In subgroup analysis, for patients with lower AFP level, the 1-, 3-, and 5-year OS rates for the two groups were significantly different (86.7, 71.9, and 71.9% for group LT vs. 75.8, 48.1, and 10.7% for group SR, P = 0.003). For patients with smaller tumor size, the 1-, 3-, and 5-year OS rates were 78.3, 66.7, and 66.7% for group LT, and 83.8, 42.6, and 18.6% for group SR, p = 0.009). Transplantation was a favorable factor associated with prognosis before and after propensity score matching (HR 2.643).

CONCLUSION

Our propensity model suggested that LT provided significantly better long-term survival than SR for HCC beyond Milan criteria before and after PSM.

摘要

背景

越来越多的研究表明，对于米兰标准以外的肝细胞癌（HCC）患者，手术切除（SR）或肝移植（LT）可带来生存获益。本研究比较了接受 SR 或 LT 的米兰标准以外 HCC 患者的长期生存情况。

材料与方法

共回顾性收集 461 例 HCC 患者。采用倾向评分匹配（PSM）、Kaplan-Meier 法和 Cox 比例风险模型进行分析。

结果

LT 组的预后明显优于 SR 组（P<0.001），PSM 后仍有差异（p=0.003）。亚组分析显示，对于 AFP 水平较低的患者，两组的 1、3、5 年 OS 率差异有统计学意义（86.7、71.9、71.9%LT 组 vs. 75.8、48.1、10.7%SR 组，P=0.003）。对于肿瘤直径较小的患者，两组的 1、3、5 年 OS 率分别为 78.3、66.7、66.7%和 83.8、42.6、18.6%，差异有统计学意义（P=0.009）。LT 是与预后相关的有利因素，在倾向评分匹配前后均有统计学意义（HR 2.643）。