肝细胞癌活体肝移植后的生存分析：一项单中心队列研究

Survival Analysis after Living Donor Liver Transplantation for Hepatocellular Carcinoma: A Single Center Cohort Study.

作者信息

Na Byung-Gon, Kim Seong-Hoon, Park Sang-Jae

机构信息

Organ Transplantation Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si 10408, Gyeonggi-do, Korea.

出版信息

Biology (Basel). 2021 May 20;10(5):446. doi: 10.3390/biology10050446.

DOI:10.3390/biology10050446

PMID:34065172

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8160725/

Abstract

BACKGROUND

Living-donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC) has been used as a curative treatment option for hepatocellular carcinoma (HCC) because of a shortage of deceased donors. This study aimed to investigate survival outcomes after LDLT for HCC.

METHOD

This study included 359 patients undergoing LDLT for HCC. We analyzed overall survival (OS) and recurrence-free survival (RFS) and the prognostic factors related to them.

RESULTS

The 5-year OS and RFS rates of patients within the Milan criteria (WM) were better than those of patients beyond the Milan criteria (BM) (87.3% vs. 64.1% and 87.6% vs. 57.8%, respectively, both < 0.05). Alpha-fetoprotein level (AFP) > 400 ng/mL (hazard ratio (HR), 2.07; 95% CI, 1.28-3.36; 0.05) and HCC of BM (HR, 2.61; 95% CI, 1.60-4.26; 0.05) at immediate pretransplant were independent risk factors of OS. AFP > 400 ng/mL (HR, 2.16; 95% CI, 1.34-3.49; < 0.05) and HCC of BM (HR, 3.01; 95% CI, 1.81-5.01; < 0.05) were also independent risk factors of RFS. In pathologic findings of explanted liver, tumor size, Edmondson-Steiner grade III-IV, and microvascular invasion were independent risk factors of both OS and RFS ( < 0.05).

CONCLUSIONS

BM and AFP > 400 ng/mL at immediate pretransplant are unfavorable predictors of survival outcomes after LDLT for HCC.

摘要

背景

由于尸体供肝短缺，活体肝移植（LDLT）已被用作肝细胞癌（HCC）的一种根治性治疗选择。本研究旨在调查LDLT治疗HCC后的生存结局。

方法

本研究纳入了359例行LDLT治疗HCC的患者。我们分析了总生存（OS）和无复发生存（RFS）以及与之相关的预后因素。

结果

米兰标准内（WM）患者的5年OS率和RFS率优于米兰标准外（BM）的患者（分别为87.3%对64.1%和87.6%对57.8%，均P<0.05）。移植前即刻甲胎蛋白水平（AFP）>400 ng/mL（风险比（HR），2.07；95%置信区间，1.28 - 3.36；P<0.05）和BM期HCC（HR，2.61；95%置信区间，1.60 - 4.26；P<0.05）是OS的独立危险因素。AFP>400 ng/mL（HR，2.16；95%置信区间，1.34 - 3.49；P<0.05）和BM期HCC（HR，3.01；95%置信区间，1.81 - 5.01；P<0.05）也是RFS的独立危险因素。在切除肝脏的病理结果中，肿瘤大小、Edmondson-Steiner III-IV级和微血管侵犯是OS和RFS的独立危险因素（P<0.05）。