Department of General Surgery, Chang-Gung Memorial Hospital, Linkou 333, Taiwan.
Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital, Linkou 333, Taiwan.
Curr Oncol. 2021 Oct 21;28(6):4281-4290. doi: 10.3390/curroncol28060364.
Human cytomegalovirus (CMV) infection has been reported to compromise liver transplantation (LT) outcomes. Recent studies have shown that CMV has a beneficial oncolytic ability. The aim of this study was to investigate the impact of CMV on tumor recurrence in patients with hepatocellular carcinoma (HCC) who underwent liver transplantation (LT). This retrospective study enrolled 280 HCC patients with LT at our institute between January 2005 and January 2016. Their relevant demographic characteristics, pre- and post-LT conditions, and explant histology were collected. A CMV pp65 antigenemia assay was performed weekly following LT to identify CMV infection. A total of 121 patients (43.2%) were CMV antigenemia-positive and 159 patients (56.8%) were negative. A significantly superior five-year recurrence-free survival was observed among CMV antigenemia-positive patients compared with the CMV-negative group (89.2% vs. 79.9%, = 0.049). There was no significant difference in overall survival between the positive and negative CMV antigenemia groups (70.2% vs. 75.3%, = 0.255). The major cause of death was HCC recurrence in CMV antigenemia-negative patients (51.3%), whereas more CMV antigenemia-positive patients died due to other bacterial or fungal infections (58.3%). In the multivariate analysis, the independent risk factors for tumor recurrence included positive CMV antigenemia ( = 0.042; odds ratio (OR) = 0.44; 95% confidence interval (CI) = 0.20-0.97), microscopic vascular invasion ( = 0.001; OR = 3.86; 95% confidence interval (CI) = 1.78-8.36), and tumor status beyond the Milan criteria ( = 0.001; OR = 3.69; 95% CI = 1.77-7.71). In conclusion, in addition to the well-known Milan criteria, human CMV is associated with a lower HCC recurrence rate after LT. However, this tumor suppressive property does not lead to prolonged overall survival, especially in severely immunocompromised patients who are vulnerable to other infections.
人类巨细胞病毒（CMV）感染已被报道会影响肝移植（LT）的结果。最近的研究表明，CMV 具有有益的溶瘤能力。本研究旨在探讨 CMV 对接受肝移植（LT）的肝细胞癌（HCC）患者肿瘤复发的影响。本回顾性研究纳入了 2005 年 1 月至 2016 年 1 月期间在我院接受 LT 的 280 例 HCC 患者。收集了他们的相关人口统计学特征、LT 前后的情况和移植肝组织学特征。LT 后每周进行一次 CMV pp65 抗原血症检测以确定 CMV 感染。共有 121 例患者（43.2%）CMV 抗原血症阳性，159 例患者（56.8%）为阴性。CMV 抗原血症阳性患者的五年无复发生存率明显优于 CMV 阴性组（89.2%比 79.9%， = 0.049）。CMV 抗原血症阳性和阴性组的总生存率无显著差异（70.2%比 75.3%， = 0.255）。CMV 抗原血症阴性患者的主要死亡原因是 HCC 复发（51.3%），而 CMV 抗原血症阳性患者更多地死于其他细菌或真菌感染（58.3%）。在多因素分析中，肿瘤复发的独立危险因素包括 CMV 抗原血症阳性（ = 0.042；优势比（OR）= 0.44；95%置信区间（CI）= 0.20-0.97）、微血管侵犯（ = 0.001；OR = 3.86；95%CI = 1.78-8.36）和超出米兰标准的肿瘤状态（ = 0.001；OR = 3.69；95%CI = 1.77-7.71）。总之，除了众所周知的米兰标准外，人类 CMV 与 LT 后 HCC 复发率降低相关。然而，这种肿瘤抑制特性并不能导致总体生存时间延长，尤其是在易发生其他感染的严重免疫功能低下患者中。
