Analysis of prognostic factors of more/equal to10 years of survival for liver cancer patients after liver transplantation.
Analysis of prognostic factors of more/equal to10 years of survival for liver cancer patients after liver transplantation.
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DOI：
10.1007/s00432-018-2756-8
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发表时间：
2018-12
影响因子：
3.6
通讯作者：
Leng X
中科院分区：
文献类型：
--
作者：
Li X;Huang L;Leng X
探讨肝癌患者肝移植后“10年以上生存期”的预后因素。连续回顾性纳入2000年5月至2007年5月在北京大学人民医院肝胆外科接受肝移植的肝癌患者134例。患者包括 120 名男性和 14 名女性。原发性肝细胞癌124例（92.5%），胆管癌9例（6.7%），混合性肝细胞癌和胆管癌1例。围手术期死亡的患者被排除在外。随访至2017年5月31日或死亡时。根据术后生存时间数据，将患者分为 < 10年组（81例）和 ≥ 10年组（53例）。记录并分析患者的临床资料，包括甲胎蛋白（AFP）水平（≥ 400 µg/L或< 400 µg/L）、肿瘤病灶数量（< 3或≥3）、肿瘤大小（≤ 5 cm或> 5 cm）、血管瘤栓（大血管或非大血管）以及组织学分化程度。 Kaplan-Meier 方法用于计算存活率。使用对数秩方法来比较生存曲线之间的差异。使用Cox比例风险回归模型对可能的影响因素进行多变量分析。 (1)对134例肝癌肝移植患者全部进行随访。随访时间为1-201个月，中位随访时间为18（8.75，132.5）个月。 Kaplan-Meier生存分析结果显示，1年、3年、5年和10年累积生存率分别为70.3%、48.6%、46.8%和46.8%。 (2)两组患者年龄、AFP≥400μg/L发生率、肿瘤组织学分化程度、血管瘤栓、肿瘤病灶大小、肿瘤病灶数量差异均有统计学意义(均P<0.01)。 （3）AFP（log-rank χ2 = 13.428）、组织病理学分化（log-rank χ2 = 33.592）、大血管瘤栓（log-rank χ2 = 36.470）、肿瘤病灶大小（log-rank χ2 = 36.470）的累积生存率不同χ2 = 39.835）和肿瘤病灶数量（对数秩χ2 = 47.016），组间差异有统计学意义（均P < 0.01）。 (4)多变量Cox比例风险回归分析显示≥ 3个肿瘤病灶[风险比(HR) = 2.879, 95%置信区间(CI) 1.566–5.422]、肿瘤病灶大小 > 5 cm(HR = 2.682, 95% CI 1.382–5.366)、大血血管癌栓（HR = 1.831，95% CI 1.010~3.341）、组织学分化差（HR = 2.150，95% CI 1.372~3.394）是影响肝癌患者肝移植术后10年生存的危险因素（均P < 0.05）。肿瘤大小、肿瘤数量、大血管瘤栓、肿瘤分化程度低均是影响肝癌患者肝移植术后10年生存率的独立危险因素。
To investigate prognostic factors of more than 10 years of survival for liver cancer patients after liver transplantation. From May 2000 to May 2007, a total of 134 liver cancer patients who underwent liver transplantation in the Department of Hepatobiliary Surgery, Peking University People’s Hospital, were continuously and retrospectively enrolled. The patients included 120 males and 14 females. There were 124 cases (92.5%) of primary hepatocellular carcinoma, 9 cases (6.7%) of cholangiocarcinoma, and 1 case of mixed hepatocellular carcinoma and cholangiocarcinoma. Patients with perioperative death were excluded. Follow-up was performed until May 31st, 2017 or the time of death. According to the data on postoperative survival time, patients were divided into a < 10 years group (81 cases) and a ≥ 10 years group (53 cases). Patients’ clinical data were recorded and analyzed, including alpha-fetoprotein (AFP) level (≥ 400 µg/L or < 400 µg/L), number of tumor lesions (< 3 or ≥ 3), tumor size (≤ 5 cm or > 5 cm), vascular tumor thrombus (large blood vessel or non-large blood vessel), and histological differentiation degree. The Kaplan–Meier method was used to calculate survival rates. The log-rank method was used to compare the differences between survival curves. The Cox proportional hazards regression model was used to perform multivariate analyses of possibly influential factors. (1) Follow-up was conducted with all 134 liver cancer patients after liver transplantation. The follow-up periods were 1–201 months, with a median of 18 (8.75, 132.5) months. The Kaplan–Meier survival analysis results showed that the 1-year, 3-year, 5-year, and 10-year cumulative survival rates were 70.3%, 48.6%, 46.8%, and 46.8%, respectively. (2) The differences in the age of patients, the incidence rate of AFP ≥ 400 µg/L, tumor histological differentiation, vascular tumor thrombi, tumor lesion size, and number of tumor lesions between two groups were all statistically significant (all P < 0.01). (3) The cumulative survival rates were different in AFP (log-rank χ2 = 13.428), histopathologic differentiation (log-rank χ2 = 33.592), large blood vessel tumor thrombi (log-rank χ2 = 36.470), tumor lesion size (log-rank χ2 = 39.835), and number of tumor lesions (log-rank χ2 = 47.016), and there were statistically significant differences between groups (all P < 0.01). (4) Multivariate Cox proportional hazards regression analyses showed that ≥ 3 tumor lesions [hazard ratio (HR) = 2.879, 95% confidence interval (CI) 1.566–5.422], tumor lesion size > 5 cm (HR = 2.682, 95% CI 1.382–5.366), large blood vessel tumor thrombi (HR = 1.831, 95% CI 1.010–3.341), and poor histological differentiation (HR = 2.150, 95% CI 1.372–3.394), were risk factors affecting the 10-year survival of liver cancer patients after liver transplantation (all P < 0.05). Tumor size, tumor number, large blood vessel tumor thrombi, and low tumor differentiation were all found to be independent risk factors affecting the 10-year survival rate after liver transplantation in liver cancer patients.
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影响因子：
6.2
作者：
Lee, Kwang-Woong;Yi, Nam-Joon;Suh, Kyung-Suk
通讯作者：
Suh, Kyung-Suk
DOI：
10.1097/meg.0000000000000029
发表时间：
2014-05-01
影响因子：
2.1
作者：
Zhang, Qing;Shang, Lei;Shen, Zhongyang
通讯作者：
Shen, Zhongyang
结合形态学标准和甲胎蛋白选择肝细胞癌患者进行肝移植可最大限度地减少移植后肿瘤复发的问题。
影响因子：
2.6
作者：
Grat, Micha;Kornasiewicz, Oskar;Lewandowski, Zbigniew;Holowko, Waclaw;Grat, Karolina;Kobryn, Konrad;Patkowski, Waldemar;Zieniewicz, Krzysztof;Krawczyk, Marek
通讯作者：
Krawczyk, Marek
影响因子：
4
作者：
Wang P;Wang C;Li H;Shi B;Wang J;Zhong L
通讯作者：
Zhong L
DOI：
10.1016/j.ajg.2012.03.006
发表时间：
2012-03-01
期刊：
Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology
影响因子：
--
作者：
Fawzy Montaser, Mohamed;Amin Sakr, Mohamed;Omar Khalifa, Mohamed
通讯作者：
Omar Khalifa, Mohamed