中国实用外科杂志

中国实用外科杂志

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挽救性肝移植治疗肝切除术后复发性肝细胞癌临床效果分析

邹卫龙，朱雄伟，李自强，张浩冲，陈新国，沈中阳   

  1. 中国人民武装警察部队总医院肝移植和肝胆胰外科，北京 100039
  • 出版日期:2018-02-01 发布日期:2018-02-24

  • Online:2018-02-01 Published:2018-02-24

摘要：

目的    观察挽救性肝移植（SLT）治疗初始肝切除（PLR）术后复发性肝细胞癌（HCC）的临床效果及可行性，分析影响无复发存活率（RFS）的风险因素。方法    回顾性分析2007年1月至2011年12月中国人民武装警察部队总医院60例PLR术后HCC复发、接受SLT病人的临床资料。分析SLT术后效果及受体RFS情况；根据随访期间复发与否，多因素分析SLT术后再次复发的风险因素，Log-rank（Mantel-Cox）评价独立风险因素对RFS的影响。 结果    病人中位随访时间3.7（0.1～9.9）年。28例（46.7%）SLT受者5年内出现肝内复发或远处转移，1、3、5年RFS分别为79.1%、64.6%、53.0%。复发肿瘤超过Milan标准、甲胎蛋白（AFP）水平≥400 μg/L、微血管侵犯是影响RFS的独立风险因素；3种风险因素相关的1、3、5年累计RFS显著降低，分别为39.9%、28.5%、22.8%，56.8%、44.7%、36.5%和24.1%、16.1%、16.1%，P＜0.05。 结论    复发肿瘤超过Milan标准、AFP水平≥400 μg/L、存在微血管侵犯是影响SLT术后RFS的独立风险因素。 SLT作为PLR术后复发性HCC的挽救措施可获得较高的RFS。

关键词: 挽救性肝移植, 肝细胞癌, 复发, 肝切除术, 无复发存活率

Abstract:

Efficacy and feasibility of salvage liver transplantation for recurrent hepatocellular carcinoma after primary liver resection        ZOU Wei-long, ZHU Xiong-wei, LI Zi-qiang, et al. Surgery of Liver Transplant and Hepatopancrobiliary, the General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China
Correponding author:SHEN Zhong-yang, E-mail：zhongyangshen@vip.sina.com
Abstract    Objective    To evaluate efficacy and feasibility of salvage liver transplantation (SLT) for recurrent hepatocellular carcinoma (HCC) after primary liver resection(PLR), and to investigate the risk factors involved in relapse-free survival (RFS) of patients underwent SLT.  Methods    A retrospective analysis was performed on clinical data of 60 patients underwent SLT for recurrent HCC after PLR，from Jan. 2007 to Dec. 2011, in Surgery of Liver Transplant and Hepatopancrobiliary, The General Hospital of Chinese People's Armed Police Forces. The efficacy and feasibility of recipients was analyzed by RFS after SLT. The risk factors involved in RFS were detected by multivariate analysis , according to relapse again or not during 5-years follow-up. The impact of independent risk factors on RFS was evaluated by Log-rank(Mantel-Cox) analysis. Results  All the patients were follow up for 3.7（0.1～9.9）years. Twenty-eight of 60 patients (46.7%) had been detected intra-hepatic relapse again and/or distal metastasis during 5 years follow-up. The total 1-、3-、5-years RFS after SLT were 79.1%, 64.6%, 53.0%, respectively. The independent risk factors, attribute to relapse again or metastasis of HCC after SLT, were recurrent tumor beyond Milan criteria, serum AFP level more than  400 μg/L, and micro-vascular invasion. 1-, 3- and 5-years RFS influenced by 3 independent risk factors, which had been depreciated significantly(P＜0.05), were 39.9%, 28.5%, 22.8%; 56.8%, 44.7%, 36.5%; 24.1%, 16.1 and 16.1%, respectively. Conclusion  The independent risk factors, involved RFS of SLT for recurrent HCC after PLR, were recurrent tumor beyond Milan criteria, serum AFP level more than 400 μg/L, and micro-vascular invasion. SLT can be used as a salvage strategy for recurrent HCC after PLR, even can obtain satisfactory clinical RFS.

Key words: salvage liver transplantation；hepatocellular carcinoma；recurrence, liver resection；relapse-free survival