卡氏行为状态对肝癌患者肝移植预后的影响。
The impact of Karnofsky performance status on prognosis of patients with hepatocellular carcinoma in liver transplantation.
机构信息
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Afliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China.
出版信息
BMC Gastroenterol. 2024 Feb 26;24(1):85. doi: 10.1186/s12876-024-03161-7.
BACKGROUND
Functional performance as measured by the Karnofsky Performance Status (KPS) scale has been linked to the outcomes of liver transplant patients; however, the effect of KPS on the outcomes of the hepatocellular carcinoma (HCC) liver transplant population has not been fully elucidated. We aimed to investigate the association between pre-transplant KPS score and long-term outcomes in HCC patients listed for liver transplantation.
METHODS
Adult HCC candidates listed on the Scientific Registry of Transplant Recipients (SRTR) database from January 1, 2011 to December 31, 2017 were grouped into group I (KPS 80-100%, n = 8,379), group II (KPS 50-70%, n = 8,091), and group III (KPS 10-40%, n = 1,256) based on percentage KPS score at listing. Survival was compared and multivariable analysis was performed to identify independent predictors.
RESULTS
Patients with low KPS score had a higher risk of removal from the waiting list. The 5-year intent-to-treat survival was 57.7% in group I, 53.2% in group II and 46.7% in group III (P < 0.001). The corresponding overall survival was 77.6%, 73.7% and 66.3% in three groups, respectively (P < 0.001). Multivariable analysis demonstrated that KPS was an independent predictor of intent-to-treat survival (P < 0.001, reference group I; HR 1.19 [95%CI 1.07-1.31] for group II, P = 0.001; HR 1.63 [95%CI 1.34-1.99] for group III, P < 0.001) and overall survival(P < 0.001, reference group I; HR 1.16 [95%CI 1.05-1.28] for group II, P = 0.004; HR 1.53 [95%CI 1.26-1.87] for group III, P < 0.001). The cumulative 5-year recurrence rates was higher in group III patients (7.4%), compared with 5.2% in group I and 5.5% in group II (P = 0.037). However, this was not significant in the competing regression analysis.
CONCLUSIONS
Low pre-transplant KPS score is associated with inferior long-term survival in liver transplant HCC patients, but is not significantly associated with post-transplant tumor recurrence.
背景
卡氏功能状态评分（KPS）量表衡量的功能表现与肝移植患者的预后相关；然而，KPS 对肝癌（HCC）肝移植人群预后的影响尚未完全阐明。我们旨在研究移植前 KPS 评分与 HCC 患者接受肝移植的长期预后之间的关系。
方法
2011 年 1 月 1 日至 2017 年 12 月 31 日，根据列表时的 KPS 百分比分数，将成人 HCC 候选者分为 I 组（KPS 80-100%，n=8379）、II 组（KPS 50-70%，n=8091）和 III 组（KPS 10-40%，n=1256）。比较生存情况并进行多变量分析以确定独立预测因素。
结果
低 KPS 评分的患者从等待名单中被移除的风险更高。I 组、II 组和 III 组的 5 年意向治疗生存率分别为 57.7%、53.2%和 46.7%（P<0.001）。相应的总体生存率分别为 77.6%、73.7%和 66.3%（P<0.001）。多变量分析表明，KPS 是意向治疗生存率的独立预测因素（P<0.001，参考 I 组；II 组 HR 1.19[95%CI 1.07-1.31]，P=0.001；III 组 HR 1.63[95%CI 1.34-1.99]，P<0.001）和总体生存率（P<0.001，参考 I 组；II 组 HR 1.16[95%CI 1.05-1.28]，P=0.004；III 组 HR 1.53[95%CI 1.26-1.87]，P<0.001）。与 I 组（5.2%）和 II 组（5.5%）相比，III 组患者（7.4%）的累积 5 年复发率更高（P=0.037）。然而，在竞争回归分析中，这并不显著。
结论
移植前低 KPS 评分与 HCC 肝移植患者的长期生存不良相关，但与移植后肿瘤复发无显著相关性。
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