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中华移植杂志(电子版)

中华移植杂志(电子版) ›› 2019, Vol. 13 ›› Issue (03) : 206 -209. doi: 10.3877/cma.j.issn.1674-3903.2019.03.009

所属专题： 文献；

论著

不同肝癌肝移植标准受者预后分析
吕少诚1, 潘冰1, 李立新1, 郎韧1, 李先亮1, 樊华1, 赵昕1, 贺强1,†()   
  1. 1. 100020　北京，首都医科大学附属北京朝阳医院肝胆外科
  • 收稿日期:2018-11-19 出版日期:2019-08-25
  • 通信作者: 贺强
  • 基金资助:
    国家自然科学基金面上项目(NSFC81471590)

Prognosis analysis of different selection criteria for liver transplantation recipients with hepatocellular carcinoma

Shaocheng Lyu1, Bing Pan1, Lixin Li1, Ren Lang1, Xianliang Li1, Hua Fan1, Xin Zhao1, Qiang He1,†()   

  1. 1. Department of Hepatobiliary Surgery, Affiliated Beijing Chaoyang Hospital of Captical Medical University, Beijing 100020, China
  • Received:2018-11-19 Published:2019-08-25
  • Corresponding author: Qiang He
  • About author:
    Corresponding author: He Qiang, Email:
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引用本文：

吕少诚, 潘冰, 李立新, 郎韧, 李先亮, 樊华, 赵昕, 贺强. 不同肝癌肝移植标准受者预后分析[J/OL]. 中华移植杂志(电子版), 2019, 13(03): 206-209.

Shaocheng Lyu, Bing Pan, Lixin Li, Ren Lang, Xianliang Li, Hua Fan, Xin Zhao, Qiang He. Prognosis analysis of different selection criteria for liver transplantation recipients with hepatocellular carcinoma[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2019, 13(03): 206-209.

目的

分析不同肝癌肝移植标准受者预后情况，评价不同标准之间的差异。

方法

回顾性分析2013年1月至2017年12月首都医科大学附属北京朝阳医院原发性肝癌肝移植受者的临床资料，比较不同肝癌肝移植标准受者的预后情况。采用单因素方差分析比较不同肝癌肝移植标准受者年龄、手术时间、无肝期时间和肿瘤最大直径，采用秩和检验比较AFP、终末期肝病模型评分和出血量。采用Kaplan-Meier法绘制生存曲线，采用Log-Rank检验比较生存率。采用卡方检验比较Child分级、肿瘤分化程度等指标。P<0.05为差异有统计学意义。

结果

根据肝移植术后病理结果，115例肝癌肝移植受者中符合米兰标准43例；符合美国加州大学旧金山分校(UCSF)标准49例，较米兰标准扩大14.0%；符合杭州标准91例，较米兰标准扩大111.6%，较UCSF标准扩大85.7%。截至2017年12月，115例受者平均随访(19±17)个月，中位生存时间41.5个月(1.0～57.0个月)。除肿瘤最大直径和肿瘤数目外，3组不同肝癌肝移植标准受者均具有可比性(P均>0.05)。不同肝癌肝移植受者术后1～4年总体和和无瘤生存曲线差异均无统计学意义(P均>0.05)。

结论

相较于米兰标准和UCSF标准而言，杭州标准安全地扩大了肝癌肝移植适用范围，使更多的原发性肝癌患者受益。

关键词: 肝移植, 原发性肝癌, 预后, 生存分析, 杭州标准, 米兰标准, 加州大学旧金山分校标准
Objective

To analyze the prognosis of patients with hepatocellular carcinoma who were selected for liver transplantation by different criteria, and then to evaluate the difference between different criteria.

Methods

The clinical data of liver transplantation recipients with hepatocellular carcinoma in Affiliated Beijing Chaoyang Hospital of Captical Medical University from January 2013 to December 2017 were retrospectively analyzed. The recipients were divided into 3 groups according to the selection criteria for liver transplantation recipients with hepatocellular carcinoma. The prognosis of recipients who were selected for liver transplantation by different criteria was compared. One way ANOVO analysis was used to compare the age, operation time, anhepatic time and maximum diameter of tumor between different group. Rank sum test was used to compare AFP, end-stage liver disease model and bleeding volume between different group. Survival curve was drawn by Kaplan-Meier method and survival rate between different group was compared by Log-Rank test. Chi-square test was used to compare the indexes including Child classification and tumor differentiation between different group. P<0.05 means statistically significant.

Results

According to the pathological results of liver transplantation, 43 of 115 liver cancer recipients met Milan criteria, 49 met University of California San Francisco (UCSF) criteria, which was 14.0% more than Milan criteria, 91 met Hangzhou criteria, which was 111.6% more than Milan criteria and 85.7% more than UCSF criteria. Up to December 2017, the average follow-up time and median survival time of 115 recipients were (19±17) months and 41.5 months respectively. Except for the maximum diameter and number of tumor, the recipients among the 3 groups were all comparable (P>0.05). No significant difference was found for 1-4 year overall survival rate and tumor-free survival curves amongthe 3 groups (P all>0.05).

Conclusions

Hangzhou criteria safely enlarges the scope of application of liver transplantation and benefits more patients with hepatocellular carcinoma compared with Milan and UCSF criteria.

Key words: Liver transplantation, Hepatocellular carcinoma, Prognosis, Survival analysis, Hangzhou criteria, Milan criteria, University of California San Francisco criteria
表1 115例肝癌肝移植受者按不同标准分组临床资料比较
分组 例数 性别(男/女，例) 年龄(±s岁) 肝炎(是/否，例) 术前治疗*(是/否，例) AFP[M(Min，Max)，ng/L] MELD评分(Min，Max)，ng/mL]
米兰标准 43 39/ 4 54±8 39/ 4 15/28 13.8(4.5, 34.0) 6.3(3.3, 10.2)
UCSF标准 49 45/ 4 55±8 45/ 4 17/32 17.3(4.6, 37.7) 6.3(3.5, 10.0)
杭州标准 91 81/10 54±8 80/11 40/51 13.9(4.7, 45.3) 7.4(4.2, 10.6)
分组 例数 Child分级(A/B/C，例) 手术时间(±s，h) 无肝期时间(±s，min) 出血量[M(Min，Max)，mL] 输血(是/否，例) 分化程度(低/中/高，例)
米兰标准 43 20/19/ 4 8.9±2.0 52±10 1000(600, 1450) 26/17 5/25/13
UCSF标准 49 24/21/ 4 8.8±1.9 53±10 1000(600, 1400) 27/22 7/28/14
杭州标准 91 43/38/10 8.9±1.9 53±11 1000(600, 1550) 56/35 12/59/20
分组 例数 肿瘤最大直径(±s，cm) 肿瘤数目(1/1～3/>3，个) 微血管侵犯(是/否，例) 免疫抑制剂(他克莫司/环孢素，例) 索拉菲尼(是/否，例)
米兰标准 43 2.3±1.0 35/ 8/ 0 11/32 32/11 16/27
UCSF标准 49 2.7±1.4 39/10/ 0 14/35 36/13 17/32
杭州标准 91 3.6±2.3ab 50/12/29ab 37/54 71/20 32/59
图1 不同肝癌肝移植受者术后1～4年总体生存曲线
图2 不同肝癌肝移植受者术后1～4年无瘤生存曲线
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