Impact of age on the prognosis after liver transplantation for patients with hepatocellular carcinoma: a single-center experience.
Impact of age on the prognosis after liver transplantation for patients with hepatocellular carcinoma: a single-center experience.
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DOI：
10.2147/ott.s93939
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发表时间：
2015
影响因子：
4
通讯作者：
Zhong L
中科院分区：
文献类型：
--
作者：
Wang P;Wang C;Li H;Shi B;Wang J;Zhong L
肝移植（LT）为肝细胞癌患者提供了最有效的治疗方法。各种术前变量与肝移植后生存率相关，但年龄对肝移植预后的影响仍有争议。回顾性分析了2001年1月至2011年12月在上海市第一人民医院（中华人民共和国）进行的290例连续肝移植治疗原发性肝癌的病例。我们比较了年轻组（小于49岁，n=135）和老年组（50岁或以上，n=155）之间的患者特征和生存曲线。然后我们对老年和年轻患者的生存危险因素进行了考克斯多变量回归分析。年龄越小，甲胎蛋白水平越高（P=0.014），肿瘤越大（P=0.038），分化越差（P=0.025），门静脉淋巴结转移（P=0.001），复发率越高（P=0.038）。老年患者的无复发生存期和总生存期显著延长（分别为P=0.020和P=0.014），但符合米兰标准的年轻患者和老年患者之间无显著差异（P>0.05）。青年组1、3、5年无复发生存率分别为59.7%、44.5%、37.3%;老年组分别为67.9%、55.3%、53.8%。青年组1、3、5年总生存率分别为68.4%、45.5%、38.9%;老年组分别为76.1%、59.7%、53.9%。甲胎蛋白≥400 ng/mL、微血管浸润和肿瘤大小>5 cm是两组预后的独立危险因素。我们中心的年轻患者倾向于表现为更具侵袭性的肿瘤，复发风险较高。我们的单中心经验表明，年轻患者应在LT前进行更严格的评估，而老年患者应在适当选择后积极考虑LT。
Liver transplantation (LT) offers the most effective treatment for hepatocellular carcinoma patients. Various preoperative variables are correlated with survival after LT, but the prognostic role of aging on LT remains controversial. Between January 2001 and December 2011, 290 consecutive transplants for patients with hepatocellular carcinoma performed in Shanghai First People’s Hospital (People’s Republic of China) were analyzed retrospectively. We compared patient characteristics and survival curves between a younger group (less than 49 years, n=135) and an aged group (50 years or older, n=155). We then performed Cox multivariate regression analysis of the risk factors for survival in aged and younger patients. Younger age was associated with higher alpha-fetoprotein (P=0.014), larger tumor size (P=0.038), poorer differentiation (P=0.025), portal lymph node metastasis (P=0.001), and higher recurrence rate (P=0.038). Aged patients had significantly longer recurrence-free survival and overall survival (P=0.020 and P=0.014, respectively); however, there were no significant differences between the younger and aged patients who met the Milan criteria (P>0.05). The 1-, 3-, and 5-year recurrence-free survival rates were 59.7%, 44.5%, and 37.3%, respectively, in the younger group, and 67.9%, 55.3%, and 53.8%, respectively, in the aged group. The 1-, 3-, and 5-year overall survival rates were 68.4%, 45.5%, and 38.9%, respectively, in the younger group, and 76.1%, 59.7%, and 53.9%, respectively, in the aged group. Alpha-fetoprotein ≥400 ng/mL, microvascular invasion, and tumor size >5 cm were independent risk factors for prognosis in both groups. Younger patients in our center tended to present with more aggressive tumors and have a higher risk of recurrence. Our single-center experience suggests that younger patients should be assessed more rigorously before LT, while aged patients should be actively considered for LT after appropriate selection.