不同肝功能Child-Pugh分级对肝癌肝移植受者预后的影响

Effect of different liver function Child-Pugh classification on clinical prognosis of hepatocellular carcinoma recipients after liver transplantation

    摘要
  • 摘要:
      目的  探讨不同Child-Pugh分级对肝细胞癌（肝癌）肝移植受者术后肝癌复发和生存的影响。
      方法  回顾性分析125例接受肝移植的肝癌受者临床资料，用Kaplan-Meier方法计算肝癌肝移植受者术后3年的无瘤生存率（DFS）和总生存率（OS）。采用Cox比例风险回归模型分析可能影响肝癌肝移植受者术后复发及生存的独立危险因素。
      结果  中位随访时间为25.6个月，3年总的DFS和OS分别为68.4%和65.7%。Child-Pugh A、B级肝癌患者（113例）的3年DFS和OS分别是68.6%和66.2%，Child-Pugh C级肝癌患者（12例）的3年DFS和OS分别是66.7%和65.6%，两者差异均无统计学意义（均为P>0.05）。Cox回归分析结果表明，血管侵犯（P=0.001）和肿瘤数目>3个（P=0.025）是影响肝癌肝移植受者复发的独立危险因素。甲胎蛋白（AFP）> 400 μg/L（P=0.035）、血管侵犯（P=0.031）和肿瘤数目>3个（P=0.008）是影响肝癌患者生存的独立危险因素。
      结论  Child-Pugh C级与A、B级肝癌患者肝移植术后预后无显著性差异，AFP、血管侵犯和肿瘤数目是影响肝癌患者肝移植术后预后的重要因素，肝移植可作为Child-Pugh C级肝癌患者的有效治疗手段。

     

    Abstract:
      Objective  To evaluate the effect of the different Child-Pugh classification on the recurrence and survival of hepatocellular carcinoma (HCC) recipients after liver transplantation.
      Methods  Clinical data of 125 HCC recipients undergoing liver transplantation were retrospectively analyzed. The 3-year disease-free survival (DFS) and overall survival (OS) rates were calculated by Kaplan-Meier survival curve. The independent risk factors probably affecting the recurrence and survival of HCC recipients after liver transplantation were identified by using Cox's proportional hazards regression model.
      Results  The median follow-up time was 25.6 months. The 3-year DFS and OS rates were 68.4% and 65.7% for all patients. The 3-year DFS and OS rates in 113 patients with Child-Pugh class A/B HCC were 68.6% and 66.2%, whereas 66.7% and 65.6% for 12 patients with Child-Pugh class C HCC with no statistical significance (all P>0.05). Cox's proportional hazards regression model demonstrated that vascular invasion (P=0.001)and the number of tumors>3 (P=0.025) were the independent risk factors for the postoperative recurrence of HCC in recipients undergoing liver transplantation. Alpha fetoprotein (AFP)>400μg/L (P=0.035), vascular invasion (P=0.031) and number of tumors>3 (P=0.008) were the independent risk factors affecting the survival of HCC patients.
      Conclusions  The postoperative prognosis does not significantly differ between Child-Pugh class C and A/B HCC patients after liver transplantation. AFP, vascular invasion and number of tumors are the risk factors affecting the clinical prognosis of HCC patients after liver transplantation. Liver transplantation is an efficacious treatment for HCC patients with Child-Pugh class C.

     

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