CAJ | 학술논문

目的评价现行肝癌肝移植适应证标准的应用情况.方法回顾性分析2个中心1999年1月至2011年12月间因原发性肝癌接受肝移植的2393例受者的资料,按米兰标准、利福尼亚大学洛杉矶分校(UCSF)标准、肿瘤TNM分期对病例进行划分.采用Kaplan-Meier生存曲线计算累积存活率,Fisher精确概率检验法对3个标准的病例进行存活率的比较.分析患者术前因素及术前相关治疗对存活率的影响.结果肝移植受者平均随访时间为23.5个月,其中符合米兰标准者占41.9％,符合UCSF标准者占67.3％,而其中超出米兰标准但符合UCSF标准者占25.4％,超出UCSF标准者占32.7％.术后全部受者1、3和5年累积存活率分别为78.5％、61.1％和57.1％.符合米兰标准者1、3和5年受者累积存活率分别为89.5％、80.2％和77.1％,符合UCSF标准者1、3和5年受者累积存活率分别为85.3％、72.6％和68.9％,而其中超出米兰标准符合UCSF标准者1、3和5年受者累积存活率分别为80.0％、62.6％和58.1％,超出UCSF标准者1、3和5年受者累积存活率分别为63.3％、33.8％和28.4％.米兰标准与UCSF标准相比较,受者累积存活率的差异无统计学意义(P＞0.05),但米兰标准与超出米兰标准但符合UCSF标准者的受者累积存活率的差异有统计学意义(P=0.04).单因素分析显示,患者术前肿瘤相关基础病因、血管侵犯情况、术前甲胎蛋白、术前抗肿瘤治疗情况(肝切除等)对受者预后存在显著影响.结论虽然符合米兰标准者肝移植的预后显著高于超出米兰标准者,但符合UCSF标准者的5年存活率也尚可.TNM分期Ⅰ期和Ⅱ期患者能够获得较好的长期预后.肿瘤相关基础病因、血管侵犯情况、术前甲胎蛋白、术前抗肿瘤治疗情况(肝切除等)是影响受者存活率的指标.
목적 평개현행간암간이식괄응증표준적응용정황.방법 회고성분석2개중심1999년1월지2011년12월간인원발성간암접수간이식적2393례수자적자료,안미란표준、리복니아대학락삼기분교(UCSF)표준、종류TNM분기대병례진행화분.채용Kaplan-Meier생존곡선계산루적존활솔,Fisher정학개솔검험법대3개표준적병례진행존활솔적비교.분석환자술전인소급술전상관치료대존활솔적영향.결과 간이식수자평균수방시간위23.5개월,기중부합미란표준자점41.9％,부합UCSF표준자점67.3％,이기중초출미란표준단부합UCSF표준자점25.4％,초출UCSF표준자점32.7％.술후전부수자1、3화5년루적존활솔분별위78.5％、61.1％화57.1％.부합미란표준자1、3화5년수자루적존활솔분별위89.5％、80.2％화77.1％,부합UCSF표준자1、3화5년수자루적존활솔분별위85.3％、72.6％화68.9％,이기중초출미란표준부합UCSF표준자1、3화5년수자루적존활솔분별위80.0％、62.6％화58.1％,초출UCSF표준자1、3화5년수자루적존활솔분별위63.3％、33.8％화28.4％.미란표준여UCSF표준상비교,수자루적존활솔적차이무통계학의의(P＞0.05),단미란표준여초출미란표준단부합UCSF표준자적수자루적존활솔적차이유통계학의의(P=0.04).단인소분석현시,환자술전종류상관기출병인、혈관침범정황、술전갑태단백、술전항종류치료정황(간절제등)대수자예후존재현저영향.결론 수연부합미란표준자간이식적예후현저고우초출미란표준자,단부합UCSF표준자적5년존활솔야상가.TNM분기Ⅰ기화Ⅱ기환자능구획득교호적장기예후.종류상관기출병인、혈관침범정황、술전갑태단백、술전항종류치료정황(간절제등)시영향수자존활솔적지표.
Objective To explore the clinical value of liver transplantation for hepatocellular carcinoma (HCC).Method Two-center 2393 patients with HCC subjec to liver transplantation from Jan.1999 to Dec.2011 were retrospectively analyzed.According to the preoperative conditions and pathological conditions,the patients were divided by the Milan criteria,UCSF criteria and TNM staging,and the constitute of patients with different standards was analyzed.Survival was analyzed by using the Kaplan-Meier survival curves,and Fisher exact test was used to compare cumulative survival rate of the three criteria.The impact of preoperative factors and preoperative treatment on survival were analyzed in all patients.Result The average follow-up period of patients was 23.5 months (1 day -139 months).The 1-,3-and 5-year cumulative survival rate was 78.5％,61.1％ and 57.1％respectively.The proportion of the patients meeting the Milan criteria,UCSF criteria,beyond the Milan criteria but within the UCSF criteria and beyond was 41.9％,67.3％,25.4％ and 32.7％,respectively.Within the Milan criteria the 1-,3-and 5-year cumulative survival rate was 89.5 ％,80.2％ and 77.1％ respectively,within the UCSF criteria that was 85.3％,72.6％ and 68.9％ respectively,beyond the Milan criteria but within the UCSF criteria that was 80.0％,62.6％ and 58.1 ％ respectively,and beyond the UCSF criteria that was 63.3％,33.8％ and 28.4％ respectively.There was no significant difference in the cumulative survival rate between Milan criteria and UCSF criteria,but cumulative survival rate for Milan criteria was higher than that beyond the Milan criteria but within the UCSF criteria (P ＜ 0.05).Univariate analysis revealed a significant effect on the prognosis of patients by preoperative tumor-related underlying cause,vascular invasion situation,preoperative AFP,and anti-cancer therapy before transplantation.Conclusion With the scarce of donor,the recipient selection criteria were more strict.Though within the Milan criteria the prognosis was significantly higher than boyond Milan criteria,UCSF criteria can still get higher 5-year survival rate.The patients with TNM stage Ⅰ and Ⅱ are able to get a better long-term prognosis.The cause of the tumor,vascular invasion,preoperative AFP level,and preoperative anti-tumor treatment exerts effects on the survival rate of patients.