比较符合米兰标准和杭州标准的肝细胞肝癌(HCC)肝移植受者术后生存及肿瘤复发情况，分析移植术后生存和肿瘤复发影响因素。

回顾性分析青岛大学附属医院器官移植中心2014年2月1日至2018年12月31日符合米兰标准和杭州标准的119例HCC肝移植受者临床资料。符合米兰标准受者79例(米兰标准组)，超出米兰标准但符合杭州标准者受者40例(杭州标准组)。所有受者肝移植术后均规律随访，收集受者性别、年龄和手术时间等临床资料。无瘤生存时间以受者移植术后发现肿瘤复发转移为观察终点，累积生存时间以受者移植术后死亡为观察终点。采用Kaplan-Meier法绘制生存曲线，采用log-rank检验比较组间累积生存率和无瘤生存率。采用Cox比例风险模型进行影响累积生存时间和无瘤生存时间的单因素和多因素分析。P<0.05为差异有统计学意义。

截至2019年7月31日，119例受者术后中位随访时间为27个月(15～43个月)，其中术后因肿瘤复发死亡11例复发转移27例。米兰标准组受者1、3和5年累积生存率分别为98.7%、90.2%和90.2%，杭州标准组分别为97.2%、73.9%和73.9%，差异均无统计学意义(χ²＝0.219、1.598和1.598，P均>0.05)。米兰标准组受者1、3和5年累积无瘤生存率分别为90.3%、82.1%和68.6%，杭州标准组分别为81.6%、56.0%和56.0%，两组受者术后1年和5年累积无瘤生存率差异均无统计学意义(χ²＝1.587和3.707，P均>0.05)，3年累积无瘤生存率差异有统计学意义(χ²＝5.543，P<0.05)。多因素分析结果证实术前有无脉管癌栓是影响其累积生存率的独立危险因素，差异有统计学意义(HR＝0.159，P<0.05)；术前有无脉管癌栓和病理分化类型是影响无瘤生存的独立危险因素，差异均有统计学意义(HR＝0.338和0.395，P均<0.05)。

符合杭州标准的HCC肝移植受者移植术后可获得较好的累积生存率及无瘤生存率，受者术前是否存在脉管癌栓及病理分化程度可以指导移植术后肿瘤复发的预防。

To compare the postoperative survival and tumor recurrence of liver transplant recipients of hepatocellular carcinoma (HCC) conforming to Milan criteria and Hangzhou criteria, and analyze the influencing factors of postoperative survival and tumor recurrence.

A retrospective analysis was made on 119 HCC patients who met Milan criteria and Hangzhou criteria for liver transplantation from February 1, 2014 to December 31, 2018 in the organ transplantation center of the Affiliated Hospital of Qingdao University. There were 79 recipients who met the Milan criteria (Milan criteria group) and 40 recipients who exceeded the Milan criteria but met the Hangzhou criteria (Hangzhou criteria group). All the included recipients received regular follow-up after liver transplantation to collect clinical data such as gender, age and time of operation. The disease-free survival time was determined by the recurrence and metastasis of tumor after transplantation, and the cumulative survival time was determined by the death of the recipient after transplantation. Kaplan-Meier method was used to draw survival curve, log-rank test was used to compare the cumulative survival rate and tumor-free survival rate between groups. Cox proportional hazards model was used to analyze the single factor and multiple factors affecting cumulative survival time and tumor-free survival time. P<0.05 was considered statistically significant.

As of July 31, 2019, the median follow-up time of 119 recipients was 27 months (15-43 months), of which 11 died of tumor recurrence and 27 relapsed and metastasized. The 1-, 3-, and 5-year cumulative survival rates in the Milan criteria group were 98.7%, 90.2% and 90.2%, respectively, and in the Hangzhou criteria group were 97.2%, 73.9% and 73.9%, respectively. No significant difference was found in the 1-, 3-, and 5-year cumulative survival rate between the 2 groups (χ²=0.219, 1.598 and 1.598, P all> 0.05). The 1-, 3-and 5-year cumulative disease-free survival rates in the Milan criteria group were 90.3%, 82.1% and 68.6%, respectively, and in the Hangzhou criteria group were 81.6%, 56.0% and 56.0%, respectively. No significant difference was found in the 1-year and 5-year cumulative disease-free survival rate between the 2 groups (χ²=1.587 and 3.707, P all >0.05), and there was statistically significant difference in the 3-year cumulative disease-free survival rate (χ²=5.543, P<0.05). Multivariate analysis showed that the presence or absence of vascular tumor thrombus before transplantation was an independent risk factor affecting the cumulative survival rate, and the difference was statistically significant (HR=0.159, P<0.05). The presence or absence of vascular tumor thrombus and pathological differentiation type before transplantation were independent risk factors affecting tumor-free survival, with statistically significant differences (HR=0.338 and 0.395, P all<0.05).

HCC liver transplant recipients who meet Hangzhou criteria can obtain satisfactory cumulative survival rate and disease-free survival rate after transplantation. Whether the recipient has vascular tumor thrombus before operation and the degree of pathological differentiation can guide the prevention of tumor recurrence after transplantation.