CAJ | 학술논문

目的总结肝移植治疗肝脏恶性肿瘤的长期疗效,筛选影响移植后肿瘤复发的危险因素.方法对单中心189例肝脏恶性肿瘤患者行肝移植的临床资料进行回顾性分析.根据肿瘤临床病理类型分别计算受者累积存活率,分析肿瘤临床病理类型与肝移植术后肿瘤复发间的关系,筛选影响肿瘤复发的相关危险因素.结果 189例中围手术期死亡19例,170例进入随访期,随访率为98.8 %.其中166例的原发疾病为原发性肝癌,3例为肝门部胆管癌,1例肝转移癌.166例原发性肝癌肝移植者术后1、3、5和10年的总体存活率分别为52 %、38 %、36 %和36 %,其中符合米兰标准者(49例)的存活率分别为96 %、87 %、87 %和87 %,超出米兰标准者(136例)的存活率分别为42 %、26 %、24 %和24 %(P＜0.05).肿瘤复发是造成肝癌肝移植受者随访期死亡的最主要原因(92.5 %).3例肝门部胆管癌和1例肝转移癌肝移植受者均于术后2年内肿瘤复发.符合米兰标准的肝癌肝移植受者术后肿瘤复发率(10.2 %)显著低于超出米兰标准者(68.4 %,P＜0.05).而在超出米兰标准者中,无大血管侵犯者移植后肿瘤复发率(95.3 %)显著低于肿瘤侵犯大血管者(55.9 %,P＜0.05).以他克莫司为主要免疫抑制剂的受者的肿瘤复发率(46.2 %)低于应用环孢素A者(68.3 %,P＜0.05).移植术前肝肿瘤经皮穿刺射频消融(RF)治疗可降低受者术后肿瘤复发风险(P=0.039,OR=0.293),而术前外周血乙型肝炎病毒(HBV)DNA＞104拷贝/L是移植术后肿瘤复发的高危因素(P=0.016,OR=2.294).结论对于符合米兰标准的肝癌患者而言,肝移植的远期疗效较好;而合并大血管侵犯者肝移植的预后不佳.移植前RF治疗有助于降低术后肿瘤复发风险,移植等待期应高度重视抗HBV治疗.
목적 총결간이식치료간장악성종류적장기료효,사선영향이식후종류복발적위험인소.방법 대단중심189례간장악성종류환자행간이식적림상자료진행회고성분석.근거종류림상병리류형분별계산수자루적존활솔,분석종류림상병리류형여간이식술후종류복발간적관계,사선영향종류복발적상관위험인소.결과 189례중위수술기사망19례,170례진입수방기,수방솔위98.8 %.기중166례적원발질병위원발성간암,3례위간문부담관암,1례간전이암.166례원발성간암간이식자술후1、3、5화10년적총체존활솔분별위52 %、38 %、36 %화36 %,기중부합미란표준자(49례)적존활솔분별위96 %、87 %、87 %화87 %,초출미란표준자(136례)적존활솔분별위42 %、26 %、24 %화24 %(P＜0.05).종류복발시조성간암간이식수자수방기사망적최주요원인(92.5 %).3례간문부담관암화1례간전이암간이식수자균우술후2년내종류복발.부합미란표준적간암간이식수자술후종류복발솔(10.2 %)현저저우초출미란표준자(68.4 %,P＜0.05).이재초출미란표준자중,무대혈관침범자이식후종류복발솔(95.3 %)현저저우종류침범대혈관자(55.9 %,P＜0.05).이타극막사위주요면역억제제적수자적종류복발솔(46.2 %)저우응용배포소A자(68.3 %,P＜0.05).이식술전간종류경피천자사빈소융(RF)치료가강저수자술후종류복발풍험(P=0.039,OR=0.293),이술전외주혈을형간염병독(HBV)DNA＞104고패/L시이식술후종류복발적고위인소(P=0.016,OR=2.294).결론 대우부합미란표준적간암환자이언,간이식적원기료효교호;이합병대혈관침범자간이식적예후불가.이식전RF치료유조우강저술후종류복발풍험,이식등대기응고도중시항HBV치료.
Objective To investigate the long-term survival of the recipients with liver malignant tumors receiving liver transplantation and determine the risk factors of tumor recurrence after liver transplantation.Methods The follow-up data of the orthotopic liver transplantation for liver malignant tumors during 1999-2010 were retrospectively analyzed.The survival rate of different pathological tumor types was analyzed respectively.The tumor recurrence rate,mortality and morbidity,and the risk factors of the tumor recurrence were also analyzed.Results 170 recipients were followed up.The follow-up duration ranged from 8-132 months.The general 1-,3-,5-,10-year survival rate was 52 %,38 %,36 %,and 36 % respectively.The 1-,3-,5-,10-year survival rate of HCC matching Millan Criteria was 96 %,87 %,87 %,87 %,while that of HCC exceeding Millan Criteria was 42 %,26 %,24 %,24 % respectively(P<0.05).Tumor recurrence was the main course of the death during follow-up period(92.5 %).The recurrence rate of HCC matching and exceeding Millan Criteria was 10.2 %,and 68.4 % respectively(P<0.05).Among the recipients exceeding Millan Criteria,the recurrence rate of HCC with and without blood vessel invasion was 95.3 %,55.9 % respectively(P<0.05).Radiofrequency ablation before transplantation could decrease the risk of tumor recurrence post-transplantation(P=0.039,OR=0.293),while the high HBV-DNA load (>104 copy/L)was the risk factor of tumor recurrence.Conclusion Orthotopic liver transplantation is an effective and safe treatment for hepatocellular carcinoma matching Millan criteria.Blood vessel invasion is regarded as the contraindication of the liver transplantation of HCC.RF is an effective bridging therapy for the HCC patients,and anti-virus therapy is important during transplant waiting period.