不同肝移植标准下原发性肝癌患者的预后分析

肝脏 ›› 2020, Vol. 25 ›› Issue (9): 915-918.

不同肝移植标准下原发性肝癌患者的预后分析

张达利, 周霞, 冯丹妮, 贺希, 王洪波, 高银杰, 孙艳玲, 张利娟, 刘振文, 刘鸿凌

100039 北京解放军总医院第五医学中心原肝移植中心

收稿日期:2020-03-14 出版日期:2020-09-30 发布日期:2020-10-22
通讯作者: 刘振文,Email:liuzhenwen@medmail.com.cn; 刘鸿凌,Email: lhl7125@sina.com
作者简介:共同第一作者:周霞
基金资助:
302医院院内课题(2014007);首都市民健康培育项目(Z161100000116058)

Prognosis analysis of liver transplantation for patients with hepatocellular carcinoma using different criteria

ZHANG Da-li, ZHOU Xia, FENG Dan-ni, HE Xi, WANG Hong-bo, GAO Yin-jie, SUN Yan-ling, ZHANG Li-juan, LIU Zhen-wen, LIU Hong-ling

Liver Transplantation Center, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China

Received:2020-03-14 Online:2020-09-30 Published:2020-10-22
Contact: LIU Zhen-wen, Email:liuzhenwen@medmail.com.cn;LIU Hong-ling, Email:lhl7125@sina.com

摘要/Abstract

摘要： 目的比较原发性肝细胞癌(hepatocellular carcinoma, HCC)肝移植患者分别符合米兰标准、Up to 7标准和杭州标准的长期预后情况。方法回顾性分析2005年1月至2019年2月解放军总医院第五医学中心因HCC行肝移植的患者,分析不同移植标准下甲胎蛋白(alpha feto-protein, AFP)水平及肿瘤生物学差异,并比较不同肝移植标准下生存情况。应用COX比例风险回归模型、Kaplan分析和log-rank检验进行统计分析。结果 391例肝细胞癌肝移植患者,与米兰标准比较,超出米兰标准但符合Up to 7标准患者在肝移植术后肿瘤复发率(13.8%比21.8%, P=0.17)和无瘤生存时间[(10.93±0.3)年比(9.5±0.7)年, P=0.14]方面比较,差异无统计学意义。超出Up to 7标准但符合杭州标准的肝癌患者在肿瘤复发率(13.8%比33.8%, P<0.01)、病死率(4.9%比23%, P<0.01)和长期总体生存时间[(12.2±0.23)年比(9.1±0.79)年, P<0.01]方面比较,差异均有统计学意义。结论超出米兰标准但符合Up to 7标准肝癌患者获得较高的长期生存率和无瘤生存率,是可以接受的肝移植标准。

关键词: 肝移植, 肝细胞癌, 米兰标准, 预后

Abstract: Objective To compare the prognosis of orthotopic liver transplantation (OLT) under three different criteria in a cohort of cirrhotic patients with hepatocellular carcinoma ( HCC). Methods A total of 391 HCC patients with OLT were enrolled in this retrospective cohort study. They were received OLT under three different criteria, i.e., Milan, “Up-to-seven” and Hangzhou. Cox proportional hazard regression analysis, Kaplan analysis and log-rank test were performed to compare the patients' recurrent rates and outcomes after OLT. P value <0.05 was considered significant. Results Compared to the patients with OLT under Milan criteria, the OLT patients exceeded Milan but within “Up-to-seven” criteria has similar recurrence rate (13.8% vs 21.8%, P=0.17) and disease-free survival (DFS) (10.93±0.3 years vs 9.5±0.7 years, P=0.14), whereas the OLT patients who exceeded “Up-to-seven” but within Hangzhou criteria had significant difference in tumor recurrence (13.8% vs 33.8%, P<0.01), HCC-related death (4.9% vs 23%, P<0.01) and long-term survival (12.2±0.23years vs 9.1±0.79 years, P<0.01). Conclusion The overall survival (OS) and DFS after OLT in HCC patients who exceed Milan but within “Up-to-seven” criteria were excellent,thus they should be offered the option of OLT.

Key words: Liver transplantation, Hepatocellular carcinoma, Milan criteria, Prognosis

张达利, 周霞, 冯丹妮, 贺希, 王洪波, 高银杰, 孙艳玲, 张利娟, 刘振文, 刘鸿凌. 不同肝移植标准下原发性肝癌患者的预后分析[J]. 肝脏, 2020, 25(9): 915-918.

ZHANG Da-li, ZHOU Xia, FENG Dan-ni, HE Xi, WANG Hong-bo, GAO Yin-jie, SUN Yan-ling, ZHANG Li-juan, LIU Zhen-wen, LIU Hong-ling. Prognosis analysis of liver transplantation for patients with hepatocellular carcinoma using different criteria[J]. Chinese Hepatolgy, 2020, 25(9): 915-918.

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