小肝癌患者微血管侵犯与肝移植后肿瘤复发及预后相关性
研究
朱阳波;徐骁;郑树森
【期刊名称】《浙江大学学报（医学版）》 【年(卷),期】2014(000)006
【摘要】Objective: To evaluate the risk factors for recurrence in patients with hepatocellular carcinoma ( HCC ) after liver transplantation ( LT ) .Methods: One hundred and fifteen small HCC patients, who met Milan criteria ( single <5 cm or showing up to three nodules, each of them <3 cm without major vascular invasion or distant metastasis) and underwent LT in our hospital from January 2007 to November 2013, were enrolled in the study.The risk factors for recurrence were analyzed by Cox regression and the influence of the Milan criteria and microvascular invasion ( MVI) on the disease-free survival ( DFS) and recurrence of patients were assessed with survival analysis and ROC method.Results: Ninety-eight out of 115 small HCC patients were included for analysis, the 1-, 3-, 5-year overall survival of patients was 91.8%,
80.6%,
79.6%
and
DFS
was
87.8%,
74.5%,
73.5%,
respectively.Survival analysis identified that MVI, macro-vascular invasion, exceeding the Milan criteria and pre-transplant down-staging treatment were related to tumor recurrence ( P <0 .05 ) . Multivariate Cox regression analysis showed that MVI and exceeding the Milan
criteria were two independent prognostic indicators for early recurrence of small HCC after LT. The 1-, 3-, 5-year DFS for 69 patients without MVI and 29 patients with MVI were 92.8%, 85.5%, 85.5%and 75.9%, 55.2%, 48.3%, respectively (P<0.01). The 1,3,5-year DFS for 84 patients meeting the Milan criteria and 14 exceeding the Milan criteria were 91.7%, 83.3%, 79.8% and 64.3%, 42.9%, 42.9%, respectively ( P <0.01 ) .Conclusion: For early HCC patients undergoing LT, the presence of MVI would predict tumor recurrence and can be an indicator for the adjuvant treatment or other salvage treatments.%目的：分析影像学上符合Milan标准的肝癌肝移植患者术后复发相关的危险因素，评估Milan标准和微血管侵犯对肝移植术后肿瘤复发的预测价值。方法：回顾性分析浙江大学医学院附属第一医院2007—2013年期间115例影像学符合Milan标准并行肝移植治疗的肝癌患者，通过单因素及多因素Cox回归分析和生存分析探究影响肝移植术后肿瘤复发的危险因素，并分析其预测价值。结果：入组的98（98／115）例患者中，术后1、3、5年总体生存率及无瘤生存率分别为91.8％、80.6％、79.6％和87.8％、74.5％、73.5％。微血管侵犯、大血管侵犯、超出Milan标准和移植前降期治疗与小肝癌肝移植术后复发显著相关（ P＜0.05）；多因素分析提示微血管侵犯和超出Milan标准是预测肝癌肝移植术后复发的独立危险因素。肝癌不伴和伴有微血管侵犯的术后1、3、5年无瘤生存率分别为92.8％、85.5％、85.5％和75.9％、55.2％、48.3％（ P＜0.01）；而术后病理检查证实符合及超出Milan 标准肝癌患者术后1、3、5年无瘤生存率分别为91.7％、83.3％、79.8％和64.3％、42.9％、42.9％（ P＜0.01）。结论：微血管侵犯多提示肝癌肝移植受
者术后肿瘤的高复发转移倾向，对指导术后早期积极的辅助治疗、密切随访及补救性治疗等都具有一定的临床意义。 【总页数】6页(658-663)
【关键词】癌,肝细胞/病理学;肝肿瘤/病理学;毛细血管;手术后期间;肿瘤侵润;肝移植/标准;存活率;回顾性研究 【作者】朱阳波;徐骁;郑树森
【作者单位】浙江大学医学院附属第一医院肝胆胰外科卫生部多器官联合移植研究重点实验室浙江省器官移植重点研究实验室，浙江杭州310003;浙江大学医学院附属第一医院肝胆胰外科卫生部多器官联合移植研究重点实验室浙江省器官移植重点研究实验室，浙江杭州310003;浙江大学医学院附属第一医院肝胆胰外科卫生部多器官联合移植研究重点实验室浙江省器官移植重点研究实验室，浙江杭州310003 【正文语种】中文 【中图分类】R657.3 【文献来源】
https://www.zhangqiaokeyan.com/academic-journal-cn_journal-zhejiang-university-medical-sciences_thesis/0201246696550.html 【相关文献】
1.肝癌肝移植术前和术中癌细胞血行转移与肿瘤分化、微血管侵犯相关性研究 [J], 吴迪; 郑虹; 高东宸; 沈中阳
2.肝癌患者外周血中循环肿瘤细胞数量与肝移植后肿瘤早期复发的相关性研究 [J], 冯锦城; 杨博; 代辰; 张波; 谭如梦; 王媒西; 魏来; 陈栋; 陈知水
小肝癌患者微血管侵犯与肝移植后肿瘤复发及预后相关性研究
