Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing, 100044, China.
J Cancer Res Clin Oncol. 2018 Dec;144(12):2465-2474. doi: 10.1007/s00432-018-2756-8. Epub 2018 Sep 26.
To investigate prognostic factors of more than 10 years of survival for liver cancer patients after liver transplantation.
From May 2000 to May 2007, a total of 134 liver cancer patients who underwent liver transplantation in the Department of Hepatobiliary Surgery, Peking University People's Hospital, were continuously and retrospectively enrolled. The patients included 120 males and 14 females. There were 124 cases (92.5%) of primary hepatocellular carcinoma, 9 cases (6.7%) of cholangiocarcinoma, and 1 case of mixed hepatocellular carcinoma and cholangiocarcinoma. Patients with perioperative death were excluded. Follow-up was performed until May 31st, 2017 or the time of death. According to the data on postoperative survival time, patients were divided into a < 10 years group (81 cases) and a ≥ 10 years group (53 cases). Patients' clinical data were recorded and analyzed, including alpha-fetoprotein (AFP) level (≥ 400 µg/L or < 400 µg/L), number of tumor lesions (< 3 or ≥ 3), tumor size (≤ 5 cm or > 5 cm), vascular tumor thrombus (large blood vessel or non-large blood vessel), and histological differentiation degree. The Kaplan-Meier method was used to calculate survival rates. The log-rank method was used to compare the differences between survival curves. The Cox proportional hazards regression model was used to perform multivariate analyses of possibly influential factors.
(1) Follow-up was conducted with all 134 liver cancer patients after liver transplantation. The follow-up periods were 1-201 months, with a median of 18 (8.75, 132.5) months. The Kaplan-Meier survival analysis results showed that the 1-year, 3-year, 5-year, and 10-year cumulative survival rates were 70.3%, 48.6%, 46.8%, and 46.8%, respectively. (2) The differences in the age of patients, the incidence rate of AFP ≥ 400 µg/L, tumor histological differentiation, vascular tumor thrombi, tumor lesion size, and number of tumor lesions between two groups were all statistically significant (all P < 0.01). (3) The cumulative survival rates were different in AFP (log-rank χ = 13.428), histopathologic differentiation (log-rank χ = 33.592), large blood vessel tumor thrombi (log-rank χ = 36.470), tumor lesion size (log-rank χ = 39.835), and number of tumor lesions (log-rank χ = 47.016), and there were statistically significant differences between groups (all P < 0.01). (4) Multivariate Cox proportional hazards regression analyses showed that ≥ 3 tumor lesions [hazard ratio (HR) = 2.879, 95% confidence interval (CI) 1.566-5.422], tumor lesion size > 5 cm (HR = 2.682, 95% CI 1.382-5.366), large blood vessel tumor thrombi (HR = 1.831, 95% CI 1.010-3.341), and poor histological differentiation (HR = 2.150, 95% CI 1.372-3.394), were risk factors affecting the 10-year survival of liver cancer patients after liver transplantation (all P < 0.05).
Tumor size, tumor number, large blood vessel tumor thrombi, and low tumor differentiation were all found to be independent risk factors affecting the 10-year survival rate after liver transplantation in liver cancer patients.
探讨肝癌患者肝移植后生存 10 年以上的预后因素。
连续回顾性收集 2000 年 5 月至 2007 年 5 月北京大学人民医院肝胆外科行肝移植术的 134 例肝癌患者的临床资料。其中男 120 例，女 14 例。原发性肝癌 124 例（92.5%），胆管细胞癌 9 例（6.7%），混合性肝癌和胆管细胞癌 1 例。排除围手术期死亡病例。随访截至 2017 年 5 月 31 日或患者死亡时间。根据术后生存时间，将患者分为<10 年组（81 例）和≥10 年组（53 例）。记录并分析患者的临床资料，包括甲胎蛋白（AFP）水平（≥400μg/L 或<400μg/L）、肿瘤病灶数（<3 个或≥3 个）、肿瘤直径（≤5cm 或>5cm）、大血管肿瘤栓子、组织学分化程度。采用 Kaplan-Meier 法计算生存率，log-rank 检验比较生存曲线差异，Cox 比例风险回归模型进行多因素分析。
（1）134 例肝癌患者肝移植后均获得随访，随访时间为 1～201 个月，中位随访时间为 18（8.75，132.5）个月。Kaplan-Meier 生存分析结果显示，患者 1 年、3 年、5 年、10 年累积生存率分别为 70.3%、48.6%、46.8%和 46.8%。（2）两组患者的年龄、AFP≥400μg/L 发生率、肿瘤组织学分化程度、大血管肿瘤栓子、肿瘤直径、肿瘤病灶数差异均有统计学意义（均 P<0.01）。（3）AFP（log-rank χ²=13.428）、肿瘤组织学分化（log-rank χ²=33.592）、大血管肿瘤栓子（log-rank χ²=36.470）、肿瘤直径（log-rank χ²=39.835）、肿瘤病灶数（log-rank χ²=47.016）的累积生存率差异均有统计学意义（均 P<0.01）。（4）多因素 Cox 比例风险回归分析显示，≥3 个肿瘤病灶（HR=2.879，95%CI 1.566～5.422）、肿瘤直径>5cm（HR=2.682，95%CI 1.382～5.366）、大血管肿瘤栓子（HR=1.831，95%CI 1.010～3.341）和肿瘤组织学分化差（HR=2.150，95%CI 1.372～3.394）是影响肝癌患者肝移植后 10 年生存的独立危险因素（均 P<0.05）。
肿瘤大小、肿瘤数目、大血管肿瘤栓子、低肿瘤分化均为肝癌患者肝移植后 10 年生存率的独立危险因素。
