肝癌肝移植生存情况及预后影响因素分析（附109例报告）

目的了解原发性肝细胞癌（肝癌）患者肝移植术后的生存情况,探讨影响其预后的危险因素。方法回顾性分析2004年1月至2007年12月中山大学附属第三医院肝移植中心的109例肝癌肝移植病例的临床资料。应用Kaplan-Meier法计算累积生存率和无瘤生存率,采用Log-rank检验和Cox回归模型分别进行无瘤生存率单因素、多因素分析。结果 109例肝癌肝移植患者中,37例肿瘤复发,占总数的33.9%,复发时间2～25（中位时间8）个月。全部病例1年、3年、5年累积生存率分别为86.9%、66.1%、56.6%,而1年、3年、5年无瘤生存率分别为78.3%、64.7%、53.1%。单因素分析显示,影响肝癌肝移植术后无瘤生存率的危险因素有肿瘤大小、肿瘤侵犯血管及病理分化程度。Cox风险回归模型多因素分析发现,肿瘤侵犯血管及病理分化程度是影响肝癌肝移植患者术后无瘤生存率的独立危险因素（均为P〈0.05）。结论影响肝癌肝移植患者术后无瘤生存率的独立危险因素是术前肿瘤侵犯血管和术后病理肿瘤分化程度,应严格筛选肝癌肝移植的适应证可有效降低术后肿瘤的复发率。

Analysis of influence factors and survival of liver transplantation for primary hepatocellular carcinoma:a report of 109 cases

Objective Analysis of effect factors and survival of liver transplantation for primary hepatocellular carcinoma（HCC）.Methods The clinical data of 109 patients underwent liver transplantation for HCC between January 2004 to December 2007 at the Liver Transplantation Center of Third Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively.The Kaplan-Meier method was used to evaluate the cumulative survival rate and tumor-free survival rate.Log-rank test and Cox regression model were used to analysis the single and muti-factor for tumor-free survival rate respectively.Results Among 109 cases,there were 37 patients（33.9%）developed tumor recurrence.The 1-year,3-year,5-year cumulative survival rates were 86.9%,66.1%,56.6%.The 1-year,3-year,5-year tumor-free survival rates were 78.3%,64.7%,53.1%.Single analysis showed that preoperative size of tumor,vascular invasion,pathology differentiation were effect on tumor-free survival rates of HCC after liver transplantation.Cox regression model analysis showed that the preoperative vascular invasion,pathology differentiation were independent risk factors of tumor-free survival rate.Conclusion The independent risk factors of tumor-free survival rate of liver transplantation for HCC include preoperative vascular invasion and pathological differentiation.Strict selection of indication of liver transplantation for HCC can reduce the rate of recurrence of tumor.