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.
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