实用器官移植电子杂志 ›› 2015, Vol. 3 ›› Issue (4): 215-221.

• 论著 • 上一篇    下一篇

乙型肝炎相关性肝癌肝移植术后远期生存风险因素的分析

张庆,陈虹,陈新国,王颖,沈中阳
  

  • 出版日期:2015-07-20 发布日期:2021-06-28

  • Online:2015-07-20 Published:2021-06-28

摘要:

目的 探讨原发性肝癌(HCC)伴乙型肝炎(乙肝)后肝硬化患者肝移植术后的生存影响因素。方法 采用回顾性分析方法,选择对北京武警医院 2005 年至 2010 年 309 例 HCC 伴乙肝后肝硬化实施肝移植术后预防性抗乙肝治疗患者,分析影响其预后的因素。结果 单因素和多因素分析显示肝移植后无瘤生存率的独立预测风险因素为 ① 肿瘤大小> 7.5 cm(P 0.011);② 肿瘤数量> 4(P 0.006); ③ 肝移植术前甲胎蛋白(AFP≥ 2 000 μg/L(P 0.024);④出现血管侵犯(P 0.048);⑤ 肝移植术前天冬氨酸转氨酶(AST)水平≥ 3 倍正常值(P 0.043);⑥ 肝移植术前碱性磷酸酶(ALP)水平≥ 2 倍正 常值(P 0.005)。肝移植术前进行抗肿瘤治疗患者较未治疗者的生存率差异有统计学意义(P 0.021)。肝移植术前甲胎蛋白(AFP)> 5 000 μg/L 是预测较差生存的风险因素(P 0.000)。结论 肝移植术前肿瘤特征、AFP、血清 AST ALP 水平是乙肝相关性肝癌肝移植术后远期生存风险的预测因素。肝移植术前进行抗肿瘤及抗乙肝病毒治疗可能有助于提高乙肝相关性肝癌患者肝移植术后的生存率。

Abstract:

Objective The risk factors of liver transplantation(LT)for hepatocellular carcinoma(HCC associated with hepatitis B virus(HBV)and cirrhosis have not been well defined. This study examines the factors that may affect LT outcome for HCC patients with HBV-induced cirrhosis(HBV-cirrhosis). Methods From 2005 to 2010,309 HCC patients with HBV-cirrhosis underwent LTs with antiviral prophylaxis were performed inthe study. Results Stratified univariate and multivariate analyses demonstrated that independent predictors for a lower recurrence-free survival rate were ① a tumor size 7.5 cm(P 0.011);② total number of tumors 4(P = 0.006);③ pre-LT serum alpha-fetoprotein(AFP)level ≥ 2 000 μg/L(P = 0.024),④ vascular invasion (P = 0.048);⑤ pre-LT aspartate aminotransferase(AST)level ≥ 3 N(3 x the normal level)(P = 0.043),and ⑥ pre-LT alkaline phosphatase(ALP)level ≥ 2N(P = 0.005). Moreover,pre-LT therapy for HCC was an independent prognostic indicator of better survival(P = 0.021),while pre-LT AFP level > 5 000 μg/L was a high risk predictor of worse survival(P = 0.000). Conclusion Pre-LT classified tumor characteristics combined with pre-LT high serum levels of AST,ALP and AFP can be reliable predictors of LT outcome in HCC patients with HBV.