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浙江大学学报(医学版)  2014, Vol. 43 Issue (6): 658-663    DOI: 10.3785/j.issn.1008-9292.2014.11.004
专题报道     
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
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
Association of microvascular invasion with recurrence and prognosis of patients with small hepatocellular carcinoma undergoing liver transplantation
ZHU Yang-bo, XU Xiao, ZHENG Shu-sen
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of medicine; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Health; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou 310003, China
全文: PDF(600 KB)  
摘要: 

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。

关键词 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    
Abstract

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.

Key wordsCarcinoma, hepatocellular/pathology    Liver neoplasms/pathology    Capillaries    Postoperative period    Neoplasm invasiveness    Liver transplantation/standards    Survival rate    Retrospective studies
收稿日期: 2014-07-27      出版日期: 2014-10-16
基金资助:

国家高技术研究发展计划(863计划)(2012AA020204).

通讯作者: 郑树森(1950- ),男,博士,主任医师,教授,博士生导师,从事肝移植及肝胆胰外科工作;E-mail: shusenzheng@zju.edu.cn   
Corresponding author: ZHENG Shu-sen, E-mail: shusenzheng@zju.edu.cn   
作者简介: 朱阳波(1989- ),男,硕士,住院医师,主要从事肝病发生发展及肝癌复发转移相关的蛋白质组学及临床应用研究;E-mail: zjhzzyb@163.com
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引用本文:

朱阳波,等. 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[J]. 浙江大学学报(医学版), 2014, 43(6): 658-663.
ZHU Yang-bo,et al. Association of microvascular invasion with recurrence and prognosis of patients with small hepatocellular carcinoma undergoing liver transplantation. Journal of ZheJiang University(Medical Science), 2014, 43(6): 658-663.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2014.11.004      或      http://www.zjujournals.com/xueshu/med/CN/Y2014/V43/I6/658

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