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肝细胞癌患者肝移植术后复发的危险因素及预后分析
Risk factors for recurrence after liver transplantation in patients with hepatocellular carcinoma and their prognosis
文章发布日期:2020年08月22日  来源:  作者:张达利,冯丹妮,张利娟,等  点击次数:617次  下载次数:32次

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【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<0.001;HR=1.10,95%CI:1.02~1.17,P=0.002)、血管侵犯(HR=1.15,95%CI:1.04~1.26,P=0.016;HR=1.10,95%CI:1.03~1.18,P=0.004)。HCC肝移植患者术后1、5和10年总生存率分别为94.8%、84.2%和83.5%;1、5和10年无瘤生存率分别为84.0%、75.1%和75.1%。AFP、大血管侵犯、BMI与肿瘤直径总和联合因素对于HCC复发患者死亡有一定的预测价值(ROC曲线下面积为0.789,95%CI:0.719~0.858)。结论 肝移植术前肿瘤生物学特征是肝移植术后肿瘤复发的关键因素。
【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 whom 78(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 were 84.0%, 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.
【关键字】:癌,肝细胞; 肝移植; 危险因素; 预后
【Key words】:carcinoma,hepatocellular; liver transplantation; risk factors; prognosis
【引证本文】:ZHANG DL, FENG DN, ZHANG LJ, et al. Risk factors for recurrence after liver transplantation in patients with hepatocellular carcinoma and their prognosis[J]. J Clin Hepatol, 2020, 36(9): 1985-1989. (in Chinese)
张达利, 冯丹妮, 张利娟, 等. 肝细胞癌患者肝移植术后复发的危险因素及预后分析[J]. 临床肝胆病杂志, 2020, 36(9): 1985-1989.

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