Li Jun-Bo, Zhao Yuan-Yuan, Dai Chen, Chen Dong, Wei Lai, Yang Bo, Chen Zhi-Shui
Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Institute of Organ Transplantation, Key Laboratory of the National Health Commission, the Ministry of Education and Chinese Academy of Medical Sciences, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Curr Med Sci. 2023 Apr;43(2):329-335. doi: 10.1007/s11596-023-2720-y. Epub 2023 Apr 2.
We aimed to identify new, more accurate risk factors of liver transplantation for liver cancer through using the Surveillance, Epidemiology, and End Results (SEER) database.
Using the SEER database, we identified patients that had undergone surgical resection for non-metastatic hepatocellular carcinoma (HCC) and subsequent liver transplantation between 2010 and 2017. Overall survival (OS) was estimated using Kaplan-Meier plotter. Cox proportional hazards regression modelling was used to identify factors independently associated with recurrent disease [presented as adjusted hazard ratios (HR) with 95% CIs].
Totally, 1530 eligible patients were included in the analysis. There were significant differences in ethnicity (P=0.04), cancer stage (P<0.001), vascular invasion (P<0.001) and gall bladder involvement (P<0.001) between the groups that survived, died due to cancer, or died due to other causes. In the Cox regression model, there were no significant differences in OS at 5 years with different operative strategies (autotransplantation versus allotransplantation), nor at survival at 1 year with neoadjuvant radiotherapy. However, neoadjuvant radiotherapy did appear to improve survival at both 3 years (HR: 0.540, 95% CI: 0.326-0.896, P=0.017) and 5 years (HR: 0.338, 95% CI: 0.153-0.747, P=0.007) from diagnosis.
This study demonstrated differences in patient characteristics between prognostic groups after liver resection and transplantation for HCC. These criteria can be used to inform patient selection and consent in this setting. Preoperative radiotherapy may improve long-term survival post-transplantation.
我们旨在通过使用监测、流行病学和最终结果（SEER）数据库，确定肝癌肝移植新的、更准确的风险因素。
利用SEER数据库，我们确定了2010年至2017年间接受非转移性肝细胞癌（HCC）手术切除并随后接受肝移植的患者。使用Kaplan-Meier绘图仪估计总生存期（OS）。采用Cox比例风险回归模型确定与复发性疾病独立相关的因素[以调整后的风险比（HR）及95%置信区间（CI）表示]。
总共1530例符合条件的患者纳入分析。在存活、因癌症死亡或因其他原因死亡的组间，种族（P=0.04）、癌症分期（P<0.001）、血管侵犯（P<0.001）和胆囊受累情况（P<0.001）存在显著差异。在Cox回归模型中，不同手术策略（自体移植与同种异体移植）的5年OS以及新辅助放疗后的1年生存率均无显著差异。然而，新辅助放疗似乎确实改善了从诊断起3年（HR：0.540，95%CI：0.326-0.896，P=0.017）和5年（HR：0.338，95%CI：0.153-0.747，P=0.007）的生存率。
本研究显示了肝癌肝切除和移植后不同预后组患者特征的差异。这些标准可用于指导该情况下的患者选择和告知同意。术前放疗可能改善移植后的长期生存。
