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目的分析对预后有显著影响的肿瘤相关因素,为肝癌肝移植适应证的选择提供依据。方法回顾性分析我院2001年4月至2006年2月间251例肝细胞癌肝移植病例,Kaplan-Meier生存率统计分析各种肿瘤相关性因素对肝癌肝移植术后生存率及无瘤生存率的影响,Log Rank 检验组间差异,COX 多因素回归分析对预后有显著影响的危险因素。结果对术后生存率和/或无瘤生存率有显著影响的因素有:大血管癌栓、淋巴结转移、Edmondson 分级、镜下癌栓、肿瘤部位、播散灶、术前甲胎蛋白(AFP)等(P<0.05或 P<0.01);而术前治疗史及肝炎背景对术后生存率及无瘤生存率差异均无统计学意义(P>0.05)。Cox 多因素分析对生存率或无瘤生存率有显著影响的指标有:大血管癌栓、肿瘤播散灶及镜下癌栓(P<0.05或 P<0.01)。结论 Edmondson 分级Ⅲ～Ⅳ级、镜下癌栓、肿瘤位于左叶或两叶、肿瘤有播散灶及术前 AFP≥300μg/L 等都是肝癌肝移植危险因素,提示预后不良。有大血管癌栓、淋巴结转移的预后极差,应列为肝癌肝移植禁忌证。
Objective To analyze the tumor related factors that have a significant effect on prognosis and provide the basis for the choice of indications of liver transplantation for liver cancer. Methods 251 cases of hepatocellular carcinoma (HCC) from April 2001 to February 2006 in our hospital were retrospectively analyzed. The Kaplan-Meier survival rates were statistically analyzed. The correlation between various tumor-related factors and survival rate and tumor-free survival after liver transplantation Rate of influence, Log Rank test differences between groups, COX multivariate regression analysis of prognostic factors significantly affect the risk factors. Results The factors that significantly influenced postoperative survival and / or disease free survival were: macrovascular tumor thrombus, lymph node metastasis, Edmondson classification, microscopic embolectomy, tumor site, disseminated site, preoperative alpha fetoprotein (AFP ) (P <0.05 or P <0.01). However, there was no significant difference in postoperative survival rate and tumor-free survival between preoperative treatment history and hepatitis background (P> 0.05). Cox multivariate analysis of survival or tumor-free survival rates significantly affect the indicators are: large vascular thrombus, disseminated tumor and microscopic emboli (P <0.05 or P <0.01). Conclusion Edmondson grading Ⅲ ~ Ⅳ grade, tumor emboli in the mirror, the tumor is located in the left lobe or both lobes, tumor with disseminated lesions and preoperative AFP ≥ 300μg / L are liver cancer risk factors for liver transplantation, suggesting a poor prognosis. A large vascular tumor thrombus, poor prognosis of lymph node metastasis, liver transplantation should be classified as contraindications for liver transplantation.