• 解放軍第八一醫(yī)院肝移植中心腫瘤外科（江蘇南京 210002）;

目的探討原發(fā)性肝癌（HCC）肝移植術(shù)后腫瘤復(fù)發(fā)或轉(zhuǎn)移的危險因素。方法回顧性我院2003年4月至2007年11月期間76例HCC患者行肝移植的臨床資料，根據(jù)隨訪期間是否有復(fù)發(fā)分為復(fù)發(fā)組（n=23）和未復(fù)發(fā)組（n=53），總結(jié)腫瘤復(fù)發(fā)的特點(diǎn)。結(jié)果76例患者中23例（30.3%）術(shù)后復(fù)發(fā)。 單因素分析顯示患者性別（P=0.449）、年齡（P=0.091）、術(shù)前是否治療（P=0.958）、腫瘤數(shù)目（P=0.212）和是否伴有HBV/HCV感染（P=0.220）與腫瘤的復(fù)發(fā)無關(guān)，而腫瘤包膜完整性（P=0.009）、腫瘤分期（P=0.002）、腫瘤直徑（P lt;0.001）、血管侵犯（P lt;0.001）以及術(shù)前AFP水平（P=0.044）與腫瘤的復(fù)發(fā)有關(guān)，其中腫瘤直徑 lt;5.0 cm（P=0.001）和術(shù)后2個月AFP水平恢復(fù)正常者(P lt;0.001) 1年復(fù)發(fā)率更低。 多因素分析顯示腫瘤直徑（P=0.001，OR=6.456，95%CI為2.356~17.680)、血管侵犯(P=0.030, OR=10.653，95%CI為1.248~90.910)以及術(shù)前AFP水平（P=0.017，OR=2.601，95%CI 為2.196~5.658)是肝移植術(shù)后腫瘤復(fù)發(fā)的獨(dú)立危險因素。結(jié)論對于腫瘤直徑 gt;5.0 cm、伴有血管侵犯以及術(shù)前AFP水平≥400 μg/L尤其術(shù)后2個月AFP水平仍高于正常者術(shù)后需加強(qiáng)監(jiān)測，必要時盡早給予抗腫瘤治療。

引用本文： 張榮生,王軒,張斌,李增才,江濤,陸雷,張冬華. 肝癌肝移植術(shù)后復(fù)發(fā)的危險因素分析. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(1): 29-32. doi: 復(fù)制

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1. Kosola S, Lauronen J, Sairanen H, et al. High survival rates after liver transplantation for hepatoblastoma and hepatocellular carcinoma [J]. Pediatr Transplant, 2010, 14(5): 646650.
2. Coelho GR, Vasconcelos KF, Vasconcelos JB, et al. Orthotopic liver transplantation for hepatocellular carcinoma: one center’s experience in the Northeast of Brazil [J]. Transplant Proc, 2009, 41(5): 17401742.
3. 李波, 嚴(yán)律南, 袁丁, 等. 肝切除術(shù)后復(fù)發(fā)性肝癌的肝臟移植 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(3): 191194.
4. 陳剛, 朱新鋒, 劉其雨, 等. 存在大血管侵犯的肝癌患者的肝移植（附8例報道） [J]. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(7): 484486.
5. 鄭樹森, 吳健. 肝移植治療原發(fā)性肝癌的價值 [J]. 中國醫(yī)學(xué)科學(xué)院學(xué)報, 2008, 30(4): 366370.
6. 鄭樹森, 陳峻, 王偉林, 等. 肝細(xì)胞癌肝移植術(shù)后復(fù)發(fā)和轉(zhuǎn)移的研究: 單中心經(jīng)驗 [J]. 中華外科雜志, 2008, 46(21): 16091613.
7. Mazzaferro V, Regalia E, Doci R. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis [J]. N Engl J Med, 1996, 34(11): 693699.
8. Regalia E, Coppa J, Pulvirenti A, et al. Liver transplantation for small hepatocellular carcinoma in cirrhosis: analysis of our experience [J]. Transplant Proc, 2001, 33(12): 14421444.
9. Toso C, Trotter J, Wei A, et al. Total tumor volume predicts risk of recurrence following liver transplantation in patients with hepatocellular carcinoma [J]. Liver Transpl, 2008, 14(8): 11071115.
10. 呂波, 文天夫. 肝癌肝移植及肝癌肝切除術(shù)后復(fù)發(fā)特點(diǎn)的比較 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(3): 166170.
11. Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: comparison of the proposed UCSF criteria with the Milan criteria and the Pittsburgh modified TNM criteria [J]. Liver Transpl, 2002, 8(9): 765774.
12. 樊嘉, 周儉, 徐泱, 等. 肝癌肝移植適應(yīng)證的選擇: 上海復(fù)旦標(biāo)準(zhǔn) [J]. 中華醫(yī)學(xué)雜志, 2006, 86(16): 12271231.
13. Iwatsuki S, Dvorchik I, Marsh JW, et al. Liver transplantation for hepatocellular carcinoma: a proposal of a prognostic scoring system [J]. J Am Coll Surg, 2000, 191(4): 389394.
14. 吳志全, 樊嘉, 邱雙健, 等. 肝癌肝移植病肝改良切除 [J]. 中華肝膽外科雜志, 2005, 11(11): 782783.
15. McHugh PP, Gilbert J, Vera S, et al. αfetoprotein and tumour size are associated with microvascular invasion in explanted livers of patients undergoing transplantation with hepatocellular carcinoma [J]. HPB (Oxford), 2010, 12(1): 5661.
16. Esnaola NF, Lauwers GY, Mirza NQ, et al. Predictors of microvascular invasion in patients with hepatocellular carcinoma who are candidates for orthotopic liver transplantation [J]. J Gastrointest Surg, 2002, 6(2): 224232.
17. 賀軼鋒, 樊嘉, 周儉, 等. 影響肝癌肝移植預(yù)后的高危因素分析及診治經(jīng)驗 [J]. 中華醫(yī)學(xué)雜志, 2006, 86(18): 12321235.
18. Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocelllular carcinoma: expansion of tumour size limits dos not adversely impact survival [J]. Hepatology, 2001, 33(6): 13941403.
19. 李耀鋒, 周丁華. AFP和AFU預(yù)測原發(fā)性肝癌肝移植術(shù)后復(fù)發(fā)的價值 [J]. 中國現(xiàn)代普通外科雜志, 2009， 12(10): 866868, 878.
  1. 1. Kosola S, Lauronen J, Sairanen H, et al. High survival rates after liver transplantation for hepatoblastoma and hepatocellular carcinoma [J]. Pediatr Transplant, 2010, 14(5): 646650.
  2. 2. Coelho GR, Vasconcelos KF, Vasconcelos JB, et al. Orthotopic liver transplantation for hepatocellular carcinoma: one center’s experience in the Northeast of Brazil [J]. Transplant Proc, 2009, 41(5): 17401742.
  3. 3. 李波, 嚴(yán)律南, 袁丁, 等. 肝切除術(shù)后復(fù)發(fā)性肝癌的肝臟移植 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(3): 191194.
  4. 4. 陳剛, 朱新鋒, 劉其雨, 等. 存在大血管侵犯的肝癌患者的肝移植（附8例報道） [J]. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(7): 484486.
  5. 5. 鄭樹森, 吳健. 肝移植治療原發(fā)性肝癌的價值 [J]. 中國醫(yī)學(xué)科學(xué)院學(xué)報, 2008, 30(4): 366370.
  6. 6. 鄭樹森, 陳峻, 王偉林, 等. 肝細(xì)胞癌肝移植術(shù)后復(fù)發(fā)和轉(zhuǎn)移的研究: 單中心經(jīng)驗 [J]. 中華外科雜志, 2008, 46(21): 16091613.
  7. 7. Mazzaferro V, Regalia E, Doci R. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis [J]. N Engl J Med, 1996, 34(11): 693699.
  8. 8. Regalia E, Coppa J, Pulvirenti A, et al. Liver transplantation for small hepatocellular carcinoma in cirrhosis: analysis of our experience [J]. Transplant Proc, 2001, 33(12): 14421444.
  9. 9. Toso C, Trotter J, Wei A, et al. Total tumor volume predicts risk of recurrence following liver transplantation in patients with hepatocellular carcinoma [J]. Liver Transpl, 2008, 14(8): 11071115.
  10. 10. 呂波, 文天夫. 肝癌肝移植及肝癌肝切除術(shù)后復(fù)發(fā)特點(diǎn)的比較 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(3): 166170.
  11. 11. Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: comparison of the proposed UCSF criteria with the Milan criteria and the Pittsburgh modified TNM criteria [J]. Liver Transpl, 2002, 8(9): 765774.
  12. 12. 樊嘉, 周儉, 徐泱, 等. 肝癌肝移植適應(yīng)證的選擇: 上海復(fù)旦標(biāo)準(zhǔn) [J]. 中華醫(yī)學(xué)雜志, 2006, 86(16): 12271231.
  13. 13. Iwatsuki S, Dvorchik I, Marsh JW, et al. Liver transplantation for hepatocellular carcinoma: a proposal of a prognostic scoring system [J]. J Am Coll Surg, 2000, 191(4): 389394.
  14. 14. 吳志全, 樊嘉, 邱雙健, 等. 肝癌肝移植病肝改良切除 [J]. 中華肝膽外科雜志, 2005, 11(11): 782783.
  15. 15. McHugh PP, Gilbert J, Vera S, et al. αfetoprotein and tumour size are associated with microvascular invasion in explanted livers of patients undergoing transplantation with hepatocellular carcinoma [J]. HPB (Oxford), 2010, 12(1): 5661.
  16. 16. Esnaola NF, Lauwers GY, Mirza NQ, et al. Predictors of microvascular invasion in patients with hepatocellular carcinoma who are candidates for orthotopic liver transplantation [J]. J Gastrointest Surg, 2002, 6(2): 224232.
  17. 17. 賀軼鋒, 樊嘉, 周儉, 等. 影響肝癌肝移植預(yù)后的高危因素分析及診治經(jīng)驗 [J]. 中華醫(yī)學(xué)雜志, 2006, 86(18): 12321235.
  18. 18. Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocelllular carcinoma: expansion of tumour size limits dos not adversely impact survival [J]. Hepatology, 2001, 33(6): 13941403.
  19. 19. 李耀鋒, 周丁華. AFP和AFU預(yù)測原發(fā)性肝癌肝移植術(shù)后復(fù)發(fā)的價值 [J]. 中國現(xiàn)代普通外科雜志, 2009， 12(10): 866868, 878.

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