CAJ | 학술논문

目的探讨影响肝移植治疗肝细胞癌(HCC)预后的相关因素.方法回顾性分析2004年8月至2011年2月间147例HCC患者接受肝移植治疗的临床资料.单因素分析共纳入14个指标:受者性别、年龄、血型、术前肝功能分级、终末期肝病模型评分、甲胎蛋白(AFP)水平、肿瘤数目、肝脏被肿瘤取代率、是否侵犯左右叶、累计肿瘤直径、是否侵犯肝包膜、大血管受侵犯、微血管受侵犯(MVI)以及HCC组织学分级.将差异有统计学意义的指标纳入Cox风险比例模型行多因素分析,筛选出独立危险因素.结果 143例受者获得完整随访,随访时间6～84个月,术后1、3年总体存活率分别为75.2％和54.7％,无瘤存活率分别为70％和59％.单因素分析显示,受者年龄、AFP水平、肿瘤数目、累计肿瘤直径、肝脏被肿瘤取代率、侵犯左右叶、侵犯肝包膜、大血管受侵犯、MVI等指标的差异有统计学意义(P＜0.05)；经多因素分析,MVI、大血管受侵犯和AFP≥400μg/L是影响HCC患者肝移植术后存活率的独立危险因素.结论 MVI、大血管受侵犯、AFP是影响HCC肝移植术后存活率的主要危险因素,肝移植术前对其进行适当干预,术中严格按照无瘤技术操作,可明显改善预后.
목적 탐토영향간이식치료간세포암(HCC)예후적상관인소.방법 회고성분석2004년8월지2011년2월간147례HCC환자접수간이식치료적림상자료.단인소분석공납입14개지표:수자성별、년령、혈형、술전간공능분급、종말기간병모형평분、갑태단백(AFP)수평、종류수목、간장피종류취대솔、시부침범좌우협、루계종류직경、시부침범간포막、대혈관수침범、미혈관수침범(MVI)이급HCC조직학분급.장차이유통계학의의적지표납입Cox풍험비례모형행다인소분석,사선출독립위험인소.결과 143례수자획득완정수방,수방시간6～84개월,술후1、3년총체존활솔분별위75.2％화54.7％,무류존활솔분별위70％화59％.단인소분석현시,수자년령、AFP수평、종류수목、루계종류직경、간장피종류취대솔、침범좌우협、침범간포막、대혈관수침범、MVI등지표적차이유통계학의의(P＜0.05)；경다인소분석,MVI、대혈관수침범화AFP≥400μg/L시영향HCC환자간이식술후존활솔적독립위험인소.결론 MVI、대혈관수침범、AFP시영향HCC간이식술후존활솔적주요위험인소,간이식술전대기진행괄당간예,술중엄격안조무류기술조작,가명현개선예후.
Objective To investigate the prognostic relevant factors of hepatocellular carcinoma (HCC) in recipients following liver transplantation (LT).Methods The clinical data of 147 cases of HCC undergoing LT between Aug. 2004 and Feb. 2011 in Nanfang Hospital were studied retrospectively.Those of significance in 14 relevant factors involving gender,age,blood-type,CTP,model of end-stage liver disease (MELD),alpha-fetoprotein (AFP),tumor number,cumulative diameter of tumor,tumor occupying proportion of the liver,bilobar involvement,envelope invasion,macrovascular invasion,and microvascular invasion (MVI),HCC histology differentiation,which were based on univariate analysis with Log-Rank,were analyzed by means of Multivariate Cox proportional hazard regression model to screen out independently relevant ones.Results 143 cases were followed up.The follow-up duration ranged from 6 to 84 months.The 1- and 3-year cumulative survival rate was 75.2％ and 54.7％ respectively.The tumor free 1- and 3-year cumulative survival rate was 70％ and 59％ respectively.Univariate ananlysis revealed that age,AFP,tumor number,cumulative diameter of tumor,tumor occupying proportion of the liver,bilobar involvement,envelope invasion,macrovascular invasion,and MVI had significant difference, In a Cox model,MVI,macrovascular invasion and AFP≥ 400 μg/L were independent prognostic factors.Conclusion MVI,macrovascular invasion and AFP are the main prognostic risk fators.Intervention and non-tumor technique should be performed preoperatively and intraoperatively,respectively.