选定标准和预防性化疗在肝移植后肿瘤复发中的作用。
Role of selected criteria and preventive chemotherapy in tumor recurrence after liver transplantation.
机构信息
Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan 430030, China; NHC Key Laboratory of Organ Transplantation, Wuhan 430030, China; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan 430030, China.
Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan 430030, China; NHC Key Laboratory of Organ Transplantation, Wuhan 430030, China; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan 430030, China.
出版信息
Hepatobiliary Pancreat Dis Int. 2020 Aug;19(4):378-383. doi: 10.1016/j.hbpd.2020.06.008. Epub 2020 Jun 21.
BACKGROUND
Long-term survival after liver transplantation (LT) for hepatocellular carcinoma (HCC) patients remains poor because of tumor recurrence. To improve the prognosis of HCC patients after LT, we aimed to identify different transplantation criteria and risk factors related to tumor recurrence and evaluate the effect of preventive chemotherapy in a single center.
METHODS
In total, data on 20 variables and the survival of 199 patients with primary HCC who underwent LT between 2005 and 2015 were included for analysis. The patients were divided into the following three groups: Group 1, within the Milan and Hangzhou criteria (n = 51); Group 2, beyond the Milan but within the Hangzhou criteria (n = 36); and Group 3, beyond the Milan and Hangzhou criteria (n = 112). Survival probabilities for the three groups were calculated using multivariate Cox regression analysis. The association between preventive therapy and HCC-recurrence after LT was analyzed by multiple logistic regression analysis.
RESULTS
Child-Pugh stage C and hepatitis B virus (HBV) infection were independent risk factors for patients with tumor recurrence who did not meet the Milan criteria. The overall survival rates of the 199 patients showed statistically significant differences among the three groups (P < 0.001). Moreover, no significant difference was noted in the survival rate between Group 1 and Group 2 (P > 0.05). Multivariate logistic regression analysis showed that postoperative prophylactic chemotherapy reduced the risk of tumor recurrence in patients who did not meet the Hangzhou and Milan criteria (OR = 0.478; 95% CI: 0.308-0.741; P = 0.001).
CONCLUSIONS
Child-Pugh classification and HBV infection were the independent risk factors of tumor recurrence in HCC patients with LT. The Hangzhou criteria were effective and analogous compared with the Milan criteria. Preventive chemotherapy significantly reduced the risk of recurrence and prolonged the survival time for HCC patients beyond the Milan and Hangzhou criteria after LT.
背景
肝癌患者肝移植（LT）后的长期存活率仍然较差，因为肿瘤会复发。为了改善 LT 后 HCC 患者的预后，我们旨在确定与肿瘤复发相关的不同移植标准和危险因素，并在单中心评估预防性化疗的效果。
方法
共分析了 2005 年至 2015 年间接受 LT 的 199 例原发性 HCC 患者的 20 个变量数据和生存情况。将患者分为以下三组：组 1，符合米兰和杭州标准（n=51）；组 2，超出米兰标准但符合杭州标准（n=36）；组 3，超出米兰和杭州标准（n=112）。使用多变量 Cox 回归分析计算三组的生存概率。采用多因素逻辑回归分析探讨预防性治疗与 LT 后 HCC 复发的关系。
结果
Child-Pugh 分期 C 和乙型肝炎病毒（HBV）感染是不符合米兰标准的肿瘤复发患者的独立危险因素。199 例患者的总体生存率在三组间差异有统计学意义（P<0.001）。此外，组 1 和组 2 之间的生存率无显著差异（P>0.05）。多因素逻辑回归分析显示，不符合杭州和米兰标准的患者术后预防性化疗可降低肿瘤复发风险（OR=0.478；95%CI：0.308-0.741；P=0.001）。
结论
Child-Pugh 分级和 HBV 感染是 LT 后 HCC 患者肿瘤复发的独立危险因素。杭州标准与米兰标准同样有效。预防性化疗可显著降低 LT 后超出米兰和杭州标准的 HCC 患者的复发风险并延长生存时间。
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