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目的 总结肝细胞癌(HCC)肝移植临床经验,探讨HCC肝移植的预后影响因素。方法 应用单因素分析和逐步Logistic回归多因素分析方法,回顾性分析自1999年1月至2003年12月我单位施行的89例HCC肝移植患者的生存情况及各项临床病理指标对预后的影响。结果 移植后6个月、1年和2年累积生存率分别为81. 8%、55. 3%和43 .7%, 6个月、1年和2年无瘤生存率分别为62 .4%、35. 6%和24 .9%;随访期间肿瘤转移复发的总发生率为52 8%;Log rank检验结果显示,影响HCC患者肝移植术后累积生存率的因素为门静脉主干或分支癌栓形成(PVTT) (χ2 =15 14,P=0. 0001)、肿瘤大小(χ2 =15. 05,P=0 .0001 )、肝硬化背景(χ2 =6 14,P=0 .0132 )、术前甲胎蛋白(AFP)水平(χ2 =5 .82,P=0. 0159)和组织学分级(χ2 =4. 61,P=0 .0319);影响无瘤生存率的因素包括PVTT(χ2 =26 .30,P<0. 0001 )、肿瘤大小(χ2 =25 .25,P<0 0001 )、AFP水平(χ2 =14. 83,P=0 .0001)、组织学分级(χ2 =12 54,P=0. 0004 )、肿瘤分布(χ2 =12 73,P=0. 0004 )、肿瘤数目(χ2 =9 81,P=0 0017)以及肝硬化背景(χ2 =9 .76,P=0 .0018)。多因素分析结果显示,与累积生存率显著相关的因素是PVTT(RR=4. 721,P=0. 001 )、年龄(RR=3. 282,P=0 .007 )和组织学分级(RR=2. 368,P=0.
Objective To summarize the clinical experience of hepatocellular carcinoma (HCC) in liver transplantation and to investigate the prognostic factors of HCC in liver transplantation. Methods The univariate analysis and stepwise logistic regression multivariate analysis were used to retrospectively analyze the survival of 89 HCC patients from January 1999 to December 2003 and the impact of various clinicopathologic parameters on the prognosis . Results The cumulative survival rates at 6 months, 1 year and 2 years after transplantation were 81.8%, 55.3% and 43.7%, respectively. The 6-month, 1-year and 2-year disease-free survival rates were 62.4 %, 35.6%, and 24.9% respectively. The overall incidence of tumor recurrence and recurrence during follow-up was 52.8%. Log rank test showed that the factors affecting the cumulative survival rate after liver transplantation in HCC patients were portal vein or branch cancer The tumor size (χ2 = 15.05, P = 0.0001), liver cirrhosis (χ2 = 6 14, P = 0.0132) Preoperative alpha-fetoprotein (AFP) levels (χ2 = 5.28, P = 0.0159) and histological grade (χ2 = 4.61, P = 0.0319); factors influencing tumor-free survival included PVTT The tumor size (χ2 = 25.25, P <0.0001), AFP level (χ2 = 14.83, P = 0.0001), histological grade (χ2 = The number of tumors (χ2 = 9 81, P = 0 0017) and cirrhosis background (χ2 = 9 .76, P = 0 .0018). The results of multivariate analysis showed that the significant correlations between cumulative survival rate and the cumulative survival rate were PVTT (RR = 4. 721, P = 0.001), age (RR = 3.282, P = .007) and histological grade = 2.368, P = 0.