Predictive Factors of Recurrence of Hepatocellular Carcinoma After Liver Transplantation: A Multivariate Analysis
Predictive Factors of Recurrence of Hepatocellular Carcinoma After Liver Transplantation: A Multivariate Analysis
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DOI：
10.1016/j.transproceed.2009.03.094
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发表时间：
2009-05-01
影响因子：
0.9
通讯作者：
Rossi, M.
中科院分区：
文献类型：
--
作者：
Lai, Q.;Merli, M.;Rossi, M.
我们分析了原位肝移植（奥尔特）后肝细胞癌（HCC）复发的预测风险因素。我们回顾性分析了1988年至2007年在我们中心接受奥尔特的109例连续HCC患者的临床资料。我们排除了第一年内因肿瘤复发以外的因素死亡的所有患者（n = 24）。其余85例患者入组复发组（A; n = 19）或无复发组（B; n = 66）。在单变量分析中，两组有11个显著差异。参数A组包括更多的女性（P = 0.05），非炎性肝移植受者（P = .003），“最多7种状态”患者（HCC，最大肿瘤的大小[cm]和肿瘤数量之和为7，P < .0001），患者超过米兰标准（MC; P < .0001）或加州大学弗朗西斯科分校（UCSF）标准（P < .0001），并且在1999年之前进行奥尔特（P = .003）。A组的病变数量更高（P = 0.035），病变直径总和更大（P <0.0001），大血管（P <0.0001）和微血管（P <0.0001）浸润的数量更多，G3-G4分级的数量增加（P = 0.006）。多变量分析显示，只有微血管侵犯（P = .007）和超过UCSF标准（P = .003）是复发的独立危险因素。具有这两种参数的患者不适合奥尔特。微血管浸润是一个很好的预测参数，但不可能在术前检测到。需要新的原位肝移植前预测风险因素来实现最佳结果。
We analyzed predictive risk factors for recurrence of hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLT). We retrospectively analyzed the clinical data from 109 consecutive HCC patients who underwent OLT at our center from 1988 to 2007. We excluded all patients who died due to factors other than tumor recurrence within the first year (n = 24). The remaining 85 patients were enrolled in either a recurrence group (A; n = 19) or a nonrecurrence group (B; n = 66). Upon univariate analysis, the 2 groups were significantly different for 11. parameters. Group A included more females (P = .05), noncirrhotic liver recipients (P = .003), "up-to 7 status" patients (HCC with 7 as the sum of the size of the largest tumor [cm] and the number of tumors, P < .0001), patients exceeding Milan criteria (MC; P < .0001) or University of California San Francisco (UCSF) criteria (P < .0001), and OLT performed before 1999 (P = .003). Group A also showed a higher number of lesions (P = .035), a greater sum of diameters of the lesions (P < .0001), a major number of macrovascular (P < .0001) and microvascular invasions (P < .0001), and an increased number of G3-G4 grading (P = .006). Only microvascular invasion (P = .007) and exceeding UCSF criteria (P = .003) were independent risk factors for recurrence upon multivariate analysis. Patients with both these parameters are not candidates for OLT. Microvascular invasion is a good predictive parameter, but is impossible to detect preoperatively. New pre-OLT predictive risk factors are needed to achieve optimal results.