Clinical study of microvascular invasion on prognosis of recipients after liver transplantation for liver cancer
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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。 -
关键词:
- 原发性肝癌 /
- 肝移植 /
- 微血管侵犯(MVI) /
- 累积生存率(OS) /
- 无复发生存率(RFS) /
- 甲胎蛋白 /
- 米兰标准 /
- 降期治疗
Abstract:Objective To evaluate the effect of microvascular invasion (MVI) on prognosis of recipients after liver transplantation for primary liver cancer (liver cancer). Methods Clinical data of 177 recipients after liver transplantation for liver cancer were retrospectively analyzed. All patients were divided into the MVI-positive group (n=64) and MVI-negative group (n=113) according to postoperative pathological examination results. Clinical data were statistically compared of all recipients between the negative and positive MVI groups. The prognosis and risk factors of liver transplantation recipients for liver cancer were analyzed. Results Among 177 recipients, 64 cases (36.2%) were positive for MVI and 113 (63.8%) negative for MVI. Compared with the MVI-negative recipients, MVI-positive recipients had significantly lower degree of tumor differentiation, higher preoperative alpha-fetaprotein (AFP) level, larger maximal tumor diameter, a larger quantity of tumors, more satellite lesions and more recipients who did not meet the Milan criteria (all P < 0.05). The 1-, 3- and 5-year overall survival (OS) and recurrence-free survival (RFS) of recipients after liver transplantation for liver cancer were 80.2%, 62.1%, 58.5% and 66.3%, 57.5%, 51.2%, respectively. The 1-, 3- and 5-year OS and RFS of MVI-positive recipients were 70%, 39%, 35% and 53%, 39%, 33%, significantly lower than 86%, 75%, 72% and 73%, 68%, 63% of their counterparts negative for MVI (all P < 0.05). Cox regression analysis showed that the maximal tumor diameter >8 cm, preoperative AFP level ≥20 ng/mL, low degree of tumor differentiation and positive MVI were the independent risk factors for OS of recipients after liver transplantation for liver cancer (all P < 0.05). Positive MVI, low degree of tumor differentiation and preoperative down-staging failure were the independent risk factors for RFS of recipients after liver transplantation for liver cancer (all P < 0.05). Conclusions MVI is of significant clinical value in predicting clinical prognosis 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值 性别[n(%)] 0.759 男 59(92) 106(94) 女 5(8) 7(6) 年龄[M(Q25,Q75),岁] 54(47, 62) 49(43, 57) 0.827 BMI(x±s, kg/m2) 22±3 23±3 0.308 MELD评分[M(Q25,Q75),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) 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值 OS(%) P值 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 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值 Wald χ2值 HR① 95% CI② P值 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 -③ 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。
②CI为可信区间。
③-为无数据。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值 Wald χ2值 HR① 95% CI② P值 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。
②CI为可信区间。 -
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