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目的分析影响胆管细胞癌患者肝移植预后的肿瘤相关因素,为肝移植受者的选择提供依据。方法12例胆管细胞癌患者接受肝移植治疗,肿瘤Edmondson分级为Ⅲ～Ⅳ级者5例;肿瘤TNM分期超过Ⅱ期者9例;肿瘤累及两叶者5例,无包膜者9例,肝门淋巴结肿大者5例,肝外膈肌浸润1例,门静脉分支有癌栓者1例;个体最大肿瘤直径平均为6.1 cm。均行经典原位肝移植。采用Kaplan-Meier生存率分析肝移植术后患者存活率及无瘤存活率,Log-Rank检验各影响因素的组间差异。结果12例术后均得到随访,随访时间7～31.2个月,中位数为18.5个月,受者的存活时间为178～905 d,中位数为370 d,其0.5、1和2年存活率分别为90.9%、61.4%及24.6%,0.5、1和2年无瘤存活率分别为46.9%、37.5%和0。8例(66.7%,8/12)于肝移植后100.6 d肿瘤复发。死亡6例,其中5例死于肿瘤复发。以肝细胞癌施行肝移植的标准(Milan标准、加州大学旧金山分校标准、上海复旦标准者、Pittsburgh标准和超过Pittsburgh标准)来评价,结果符合各标准患者肝移植后的存活率及无瘤存活率的差异均无统计学意义。淋巴结转移或门静脉癌栓、TNM分期为Ⅲ期、Edmondson分级为Ⅲ级、肿瘤累及两叶、肿瘤无包膜及术前糖链抗原19-9≥37 kU/L等,可能对预后有一定影响。结论胆管细胞癌患者施行肝移植的预后不佳,应慎重选择,尽量以小肝癌为主,对肿瘤过大、TNM分期为Ⅲ期、肿瘤分布于两叶、无法排除淋巴结转移或门静脉癌栓者,应列为肝移植禁忌证。
Objective To analyze the tumor related factors that affect the prognosis of hepatocellular carcinoma in patients with cholangiocarcinoma and provide basis for the choice of recipients of liver transplantation. Methods Twelve patients with cholangiocarcinoma undergoing liver transplantation were treated with Edmondson grading of grade Ⅲ ~ Ⅳ in 5 cases. Nine patients with stage Ⅱ TNM were found in 9 cases. Five cases with two - 5 cases of portal lymphadenectasis, 1 case of extrahepatic diaphragmatic infiltration, and 1 case of portal vein thrombosis. The mean maximum tumor diameter of individuals was 6.1 cm. All patients underwent classical orthotopic liver transplantation. The Kaplan-Meier survival rate was used to analyze the survival rate and tumor-free survival rate after liver transplantation. Log-Rank test was used to analyze the differences between the groups. Results All the 12 cases were followed up for 7-31.2 months with a median of 18.5 months. The survival time of the recipients was 178-905 days with a median of 370 days. The patients were followed up for 0.5, 1, and 2 years Survival rates were 90.9%, 61.4% and 24.6%, respectively. The 0.5, 1, 2 year disease free survival rates were 46.9%, 37.5% and 0.8% (66.7%, 8/12) relapse. 6 died, of which 5 died of tumor recurrence. The standard of liver transplantation for hepatocellular carcinoma (Milan standard, University of California San Francisco standard, Shanghai Fudan standard, Pittsburgh standard and Pittsburgh standard) were evaluated, and the results were in line with the standard of survival after liver transplantation and tumor-free survival rate The difference was not statistically significant. Lymph node metastasis or portal vein tumor thrombus, TNM stage Ⅲ, Edmondson grade Ⅲ, the tumor involving the two lobes, tumor non-enveloped and preoperative glycogenic antigen 19-9 ≥ 37 kU / L, may have some impact on the prognosis . Conclusions The prognosis of patients with cholangiocarcinoma who underwent liver transplantation is poor. Prophylaxis should be performed carefully. Small hepatocellular carcinoma is the main factor. The tumor size is too large, the TNM stage is stage III, the tumor is located in the two lobes, and lymph node metastasis or portal vein tumor thrombus can not be excluded , Should be listed as contraindications to liver transplantation.