肝细胞癌患者肝移植术后复发的危险因素及预后分析

张达利; 冯丹妮; 张利娟; 汤汝佳; 贺希; 周霞; 高银杰; 刘振文; 刘鸿凌

doi:10.3969/j.issn.1001-5256.2020.09.015

肝细胞癌患者肝移植术后复发的危险因素及预后分析

DOI: 10.3969/j.issn.1001-5256.2020.09.015

解放军总医院第五医学中心肝移植中心

基金项目:

首都市民健康培育(Z161100000116058)；解放军总医院第五医学中心资金项目(YNKT2014006)；

详细信息

中图分类号: R735.7
计量
- 文章访问数: 1278
- HTML全文浏览量: 44
- PDF下载量: 115
- 被引次数: 0
出版历程
- 出版日期: 2020-09-20

Risk factors for recurrence after liver transplantation in patients with hepatocellular carcinoma and their prognosis

Liver Transplantation Center, The Fifth Medical Center of Chinese PLA General Hospital

Research funding:

摘要

摘要:
目的探讨肝细胞癌（HCC）患者肝移植术后肿瘤复发和死亡的危险因素,了解患者生存情况。方法选取2005年1月-2019年2月于解放军总医院第五医学中心行肝移植的391例HCC患者。根据肝移植术后HCC是否复发分为HCC复发组（n=78）和无复发组（n=313）。计量资料两组间比较采用t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验。利用单因素和多因素Cox比例风险回归模型分析肝移植术后患者HCC复发和死亡的危险因素。应用Kaplan-Meier法分析生存情况,并通过受试者工作特征曲线（ROC曲线）分析肝移植术后肿瘤死亡相关危险因素的预测价值。结果 391例HCC肝移植患者的中位随访时间2年,其中78例（19.95%）患者出现HCC复发。肝移植术后患者肿瘤复发和死亡的独立危险因素包括术前AFP水平> 200 ng/ml[风险比（HR）=2.52,95%可信区间（95%CI）:1.58～4.03,P <0.001; HR=2.99,95%CI:1.59～5.62,P <0.001]、肿瘤直径总和（HR=1.20,95%CI:1.12～1.28,P &...
- 癌,肝细胞 /
- 肝移植 /
- 危险因素 /
- 预后
Abstract:
Objective To investigate the risk factors for tumor recurrence and death after liver transplantation in patients with hepatocellular carcinoma( HCC) and their survival. Methods The patients with HCC who underwent liver transplantation in The Fifth Medical Center of Chinese PLA General Hospital from January 2005 to February 2019 were enrolled,and according to the presence or absence of HCC recurrence after liver transplantation,they were divided into recurrence group and non-recurrence group. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate Cox proportional-hazards regression model analyses were used to determine the risk factors for HCC recurrence and death after liver transplantation. The Kaplan-Meier method was used for survival analysis,and the receiver operating characteristic( ROC) curve was used to investigate the predictive value of death-related risk factors after liver transplantation. Results A total of 391 HCC patients who underwent liver transplantation were enrolled,with a median follow-up time of 2 years,among whom78( 19. 95%) experienced HCC recurrence. Preoperative alpha-fetoprotein( AFP) level > 200 ng/ml( recurrence: hazard ratio [HR]=2. 52,95% confidence interval [CI]: 1. 58-4. 03,P < 0. 001; death: HR = 2. 99,95% CI: 1. 59-5. 62,P < 0. 001],total tumor diameter( recurrence: HR = 1. 20,95% CI: 1. 12-1. 28,P < 0. 001; death: HR = 1. 10,95% CI: 1. 02-1. 17,P = 0. 002),and vascular invasion( recurrence: HR = 1. 15,95% CI: 1. 04-1. 26,P = 0. 016; death: HR = 1. 10,95% CI: 1. 03-1. 18,P = 0. 004) were independent risk factors for tumor recurrence and death after liver transplantation. The 1-,5-,and 10-year overall survival rates after liver transplantation were 94. 8%,84. 2%,and 83. 5%,respectively,and the 1-,5-,and 10-year disease-free survival rates were84. 0%,75. 1%,and 75. 1%,respectively. AFP,involvement of major blood vessels,body mass index,and total tumor diameter had a certain value in predicting the death of HCC patients with recurrence,with an area under the ROC curve of 0. 789( 95% CI: 0. 719-0. 858). Conclusion Tumor biological features before transplantation are the key factors for tumor recurrence after transplantation.
- carcinoma,hepatocellular /
- liver transplantation /
- risk factors /
- prognosis

HTML全文

参考文献(13)

[1] Global Burden of Disease Liver Cancer Collaboration,AKINYEMIJU T,ABERA S,et al. The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global,regional,and national level:Results from the global burden of disease study2015[J]. JAMA Oncol,2017,3(12):1683-1691.

[2] European Association for the Study of the Liver. EASL clinical practice guidelines:Management of hepatocellular carcinoma[J]. J Hepatol,2018,69(1):182-236.

[3] MAZZAFERRO V,REGALIA E,DOCI R,et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis[J]. N Engl J Med,1996,334(11):693-699.

[4] SEO CG,YIM SY,UM SH,et al. Survival according to recurrence patterns after resection for transplantable hepatocellular carcinoma in HBV endemic area:Appraisal of liver transplantation strategy[J]. Clin Res Hepatol Gastroenterol, 2019:S2210-7401(19)30257-8.

[5] CHAN KM,WU TH,CHENG CH,et al. Advantage of early liver transplantation whenever indicated for hepatocellular carcinoma recurrence after primary liver resection[J]. Biomed J,2019,42(5):335-342.

[6] NITTA H,ALLARD MA,SEBAGH M,et al. Prognostic value and prediction of extratumoral microvascular invasion for hepatocellular carcinoma[J]. Ann Surg Oncol,2019,26(8):2568-2576.

[7] CARRION AF,MARTIN P. When to refer for liver transplantation[J]. Am J Gastroenterol,2019,114(1):7-10.

[8] STERNBY EILARD M,HOLMBERG E,NAREDI P,et al. Addition of alfa fetoprotein to traditional criteria for hepatocellular carcinoma improves selection accuracy in liver transplantation[J]. Scand J Gastroenterol,2018,53(8):976-983.

[9] MAZZAFERRO V,SPOSITO C,ZHOU J,et al. Metroticket 2. 0model for analysis of competing risks of death after liver transplantation for hepatocellular carcinoma[J]. Gastroenterology,2018,154(1):128-139.

[10] SHI XL,WANG JZ,JIANG HC,et al. Research progress of vascular factors affecting recurrence of liver cancer patients after liver transplantation[J]. Ogran Transplantation,2019,10(6):727-730.(in Chinese)石鑫林，王继洲，姜洪池，等．影响肝癌患者肝移植术后复发的血管因素研究进展[J]．器官移植，2019,10(6):727-730.

[11] MEHTA N,DODGE JL,ROBERTS JP,et al. Alpha-fetoprotein decrease from> 1,000 to <500 ng/ml in patients with hepatocellular carcinoma leads to improved posttransplant outcomes[J]. Hepatology,2019,69(3):1193-1205.

[12] DUVOUX C,ROUDOT-THORAVAL F,DECAENS T,et al.Liver transplantation for hepatocellular carcinoma:A model includingα-fetoprotein improves the performance of Milan criteria[J]. Gastroenterology,2012,143(4):986-994.

[13] ZHAO ZC,WANG JD. Research progress of microRNA and tumor recurrence after liver transplantation in liver cancer[J].Ogran Transplantation,2017,8(3):238-241.(in Chinese)赵之聪，王健东．微小RNA与肝癌肝移植术后肿瘤复发的研究进展[J]．器官移植，2017,8(3):238-241.

施引文献

资源附件(0)

访问统计