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微血管侵犯对肝癌肝移植受者预后影响的临床研究

王建丰 曾凯宁 李海波 邓宜南 张英才 张彤 易述红 汪根树 杨扬 陈规划

王建丰, 曾凯宁, 李海波, 等. 微血管侵犯对肝癌肝移植受者预后影响的临床研究[J]. 器官移植, 2021, 12(3): 309-316. doi: 10.3969/j.issn.1674-7445.2021.03.009
引用本文: 王建丰, 曾凯宁, 李海波, 等. 微血管侵犯对肝癌肝移植受者预后影响的临床研究[J]. 器官移植, 2021, 12(3): 309-316. doi: 10.3969/j.issn.1674-7445.2021.03.009
Wang Jianfeng, Zeng Kaining, Li Haibo, et al. Clinical study of microvascular invasion on prognosis of recipients after liver transplantation for liver cancer[J]. ORGAN TRANSPLANTATION, 2021, 12(3): 309-316. doi: 10.3969/j.issn.1674-7445.2021.03.009
Citation: Wang Jianfeng, Zeng Kaining, Li Haibo, et al. Clinical study of microvascular invasion on prognosis of recipients after liver transplantation for liver cancer[J]. ORGAN TRANSPLANTATION, 2021, 12(3): 309-316. doi: 10.3969/j.issn.1674-7445.2021.03.009

微血管侵犯对肝癌肝移植受者预后影响的临床研究

doi: 10.3969/j.issn.1674-7445.2021.03.009
基金项目: 

国家“十三五”重大科技专项 2017ZX10203205-006-001

国家重点研发计划项目 2017YFA0104304

国家自然科学基金 81972286

广东省自然科学基金 2015A030312013

广东省科技项目 20169013

广州市科技项目 201508020262

详细信息
    作者简介:

    王建丰,男,1994年生,硕士研究生,住院医师,研究方向为肝癌肝移植,Email:393501498@qq.com

    通讯作者:

    杨扬,男,1971年生,博士,教授,主任医师,研究方向为肝移植、移植免疫、干细胞在肝脏疾病中的应用等,Email: yysysu@163.com

  • 中图分类号: R617, R735.7

Clinical study of microvascular invasion on prognosis of recipients after liver transplantation for liver cancer

More Information
  • 摘要:   目的  探讨微血管侵犯(MVI)对原发性肝癌(肝癌)肝移植受者预后的影响。  方法  回顾性分析177例肝癌肝移植受者的临床资料,根据术后病理学检查结果分为MVI阳性组(64例)和MVI阴性组(113例)。比较MVI阴性组和MVI阳性组受者的临床资料;分析肝癌肝移植受者的预后及危险因素。  结果  177例受者中,64例(36.2%)MVI阳性,113例(63.8%)MVI阴性。与MVI阴性受者相比,MVI阳性受者的肿瘤分化程度低、术前甲胎蛋白(AFP)水平高、肿瘤最大直径大、肿瘤数量多、伴卫星灶多、不符合米兰标准的例数多(均为P < 0.05)。肝癌肝移植受者1、3、5年累积生存率(OS)和无复发生存率(RFS)分别为80.2%、62.1%、58.5%和66.3%、57.5%、51.2%。MVI阳性受者的1、3、5年OS和RFS分别为70%、39%、35%和53%、39%、33%,低于MVI阴性受者的86%、75%、72%和73%、68%、63%,差异均有统计学意义(均为P < 0.05)。Cox回归分析结果显示,肿瘤最大直径>8 cm、术前AFP水平≥20 ng/mL、肿瘤中低分化和MVI阳性是影响肝癌肝移植受者OS的独立危险因素(均为P < 0.05),MVI阳性、肿瘤中低分化以及术前未降期成功是影响肝癌肝移植受者RFS的独立危险因素(均为P < 0.05)。  结论  MVI对预测肝癌肝移植受者的预后具有重要的临床价值。

     

  • 图  1  肝癌肝移植受者的生存曲线

    Figure  1.  Survival curves of recipients after liver transplantation for liver cancer

    表  1  两组受者临床资料的比较

    Table  1.   Comparison of clinical data of recipients between two groups

    变量 MVI阳性组(n=64) MVI阴性组(n=113) P
    性别[n(%)] 0.759
      男 59(92) 106(94)
      女 5(8) 7(6)
    年龄[MQ25Q75),岁] 54(47, 62) 49(43, 57) 0.827
    BMI(x±s, kg/m2 22±3 23±3 0.308
    MELD评分[MQ25Q75),分] 9(6, 11) 7(9, 12) 0.829
    肿瘤分化程度[n(%)] < 0.001
      高 2(3) 32(28)
      中 49(77) 73(65)
      低 13(20) 8(7)
    术前AFP水平[n(%)] < 0.001
       < 20 ng/mL 14(22) 58(51)
      20~400 ng/mL 21(33) 26(23)
      >400 ng/mL 29(45) 29(26)
    Child- Pugh分级[n(%)] 0.254
      A级 43(67) 87(77)
      B级 20(31) 24(21)
      C级 1(2) 2(2)
    肿瘤最大直径[n(%)] 0.009
       < 3 cm 17(27) 45(40)
      3~8 cm 26(41) 52(46)
      >8 cm 21(33) 16(14)
    肿瘤数量[n(%)] < 0.001
      1个 20(31) 62(55)
      2个 10(16) 16(14)
      ≥3个 34(53) 35(31)
    有否卫星灶[n(%)] < 0.001
      有 25(39) 20(18)
      否 39(61) 93(82)
    是否符合米兰标准[n(%)] < 0.001
      是 9(14) 52(46)
      否 55(86) 61(54)
    下载: 导出CSV

    表  2  影响肝癌肝移植受者RFS和OS危险因素的单因素分析

    Table  2.   Univariate analysis of risk factors for RFS and OS of recipients after liver transplantation for liver cancer

    变量 n RFS(%) P OS(%) P
    1年 3年 5年 1年 3年 5年
    年龄 0.487 0.801
      ≥60岁 134 64 56 51 81 63 59
       < 60岁 43 77 61 54 81 61 57
    MELD评分 0.810 0.548
      ≤10分 71 67 57 49 84 64 60
      >10分 106 64 56 54 76 58 56
    肿瘤分化程度 < 0.001 < 0.001
      高 34 100 97 94 100 97 97
      中 122 59 50 42 77 58 54
      低 21 42 26 21 62 29 19
    术前AFP水平 < 0.001 < 0.001
       < 20 ng/mL 72 87 77 68 96 86 81
      20~400 ng/mL 47 57 52 50 68 53 53
      >400 ng/mL 58 46 35 31 69 40 36
    肿瘤最大直径 < 0.001 < 0.001
       < 3 cm 62 78 71 60 87 74 72
      3~8 cm 78 66 59 55 81 63 60
      >8 cm 37 44 27 27 65 40 33
    肿瘤数量 < 0.001 < 0.005
      1个 82 71 65 57 85 71 66
      2个 26 81 77 68 89 77 77
      ≥3个 69 52 37 35 70 46 42
    有否卫星灶 < 0.001 < 0.001
      有 45 40 18 18 64 29 26
      否 132 75 71 63 86 73 70
    有否MVI < 0.001 < 0.001
      有 64 53 39 33 70 39 35
      否 113 73 68 63 86 75 72
    术前是否成功降期 < 0.001 < 0.005
      是 25 92 92 85 100 96 96
      否 152 60 50 45 77 57 52
    下载: 导出CSV

    表  3  影响肝癌肝移植受者OS危险因素的多因素分析

    Table  3.   Multivariate analysis on the risk factors of OS of recipients after liver transplantation for liver cancer

    变量 β Wald χ2 HR 95% CI P
    有否MVI 0.532 4.649 1.703 1.050~2.764 0.031
    肿瘤分化程度 0.769 11.099 2.158 1.372~3.392 < 0.001
    术前AFP水平 15.851 < 0.001
       < 20 ng/mL 参考值 - 1.000 - -
      20~400 ng/mL 0.989 8.196 2.688 1.366~5.289 0.004
      >400 ng/mL 1.304 15.738 3.684 1.934~7.016 < 0.001
    肿瘤最大直径 6.577 0.040
       < 3 cm 参考值 - 1.000 - -
      3~8 cm 0.271 0.807 1.311 0.726~2.368 0.369
      >8 cm 0.820 6.161 2.270 1.188~4.335 0.013
    注:①HR为风险比。
    CI为可信区间。
    ③-为无数据。
    下载: 导出CSV

    表  4  影响肝癌肝移植受者RFS危险因素的多因素分析

    Table  4.   Multivariate analysis on the risk factors of RFS of recipients after liver transplantation for liver cancer

    变量 β Wald χ2 HR 95% CI P
    有否MVI 0.548 5.238 1.730 1.082~2.765 0.022
    肿瘤分化程度 0.894 16.004 2.445 1.578~3.789 < 0.001
    术前是否成功降期 0.621 7.098 1.861 1.178~2.938 0.008
    注:①HR为风险比。
    CI为可信区间。
    下载: 导出CSV
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  • 收稿日期:  2021-02-04
  • 网络出版日期:  2021-05-19
  • 刊出日期:  2021-05-15

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