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| 肝癌临床病理特征与肝移植术后预后的多因素相关分析 |
| 曹晓伟1,季峻松1,陈婷1,郭闻渊2,施晓敏2,高晓钢2,倪之嘉2,王正昕2,傅宏2,马钧2,丁国善2,傅志仁2* |
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| (1.第二军医大学长征医院闸北分院肝移植科，上海 200070;2.第二军医大学长征医院全军器官移植研究所，上海 200003) |
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| 摘要: |
| 目的:评估肝细胞癌(hepatocellular carcinoma，HCC) 临床病理特征对肝移植预后的影响。 方法:回顾性分析272例肝细胞癌行肝移植受者的临床资料，寿命表法计算生存率，Kaplan-Meier法绘制术后累计生存率曲线，Log-rank检验行生存曲线之间的比较，COX比例风险回归模型进行单因素和多因素分析。 结果:单因素分析提示影响HCC预后的临床及病理因素包括终末期肝病模型(MELD)、甲胎蛋白、肿瘤大小、侵犯包膜、Eggel’s分类、微血管浸润、淋巴结转移和TNM分期，多因素分析发现甲胎蛋白(RR:1.459, P=0.002)、Eggel分类(RR:1.617, P=0.004)、微血管浸润(RR:2.631, P<0.001) 和MELD(RR:2.194, P=0.011) 是影响HCC预后的独立因素。结论:甲胎蛋白、Eggel’s分类、微血管浸润和MELD是影响HCC预后的独立因素，MELD对成人肝癌肝移植预后的影响应引起临床重视。 |
| 关键词: 肝肿瘤 肝细胞癌 肝移植 预后 病理学 COX比例风险模型 |
| DOI：10.3724/SP.J.1008.2008.01086 |
| 投稿时间：2008-05-06修订日期：2008-07-01 |
| 基金项目: |
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| Correlation between prognosis and histopathologic factors in patients with hepatocellular carcinoma after liver transplantation: a multivariate analysis |
| CAO Xiao-wei1, JI Jun-song1, CHEN Ting1, GUO Wen-yuan2, SHI Xiao-min2 , GAO Xiao-gang2, NI Zhi-jia2, WANG Zheng-xin2, FU Hong2, MA Jun2, DING Guo-shan |
| (1. Department of Liver Transplantation, Zhabei Branch of Changzheng Hospital, Second Military Medical University, Shanghai 200070，China;2. Organ Transplantation Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai 200003) |
| Abstract: |
| Objective:To evaluate the effect of histopathologic factors in patients with hepatocellular carcinoma after liver transplantation(LT) on the prognosis of liver transplantation. Methods: The clinical data of 272 HCC patients, who had received liver transplantation, were retrospectively analyzed. The survival rates were analyzed using the actuarial life-table method. Multivariate and univariate COX proportional hazards model were used to investigate the correlation between histopathologic factors and survival time. Kaplan-Meier method was used to plot the curves of accumulative survival rates and Log-rank tests were used to compare the curve of the survival rates. Results: Univariate analysis using a COX model revealed that scores of model of endstage liver disease(MELD), alphafetoprotein, size of tumor, capsule invasion, Eggel’s classification, Edmonson-Steiner grade, microvascular invasion, regional lymph node metastasis and TNM staging were significantly related to the prognosis of the patient after LT(P<0.05) . Multivariate COX model analysis showed that alphafetoprotein(RR:1.459, P=0.002) , Eggel’s classification(RR:1.617, P=0.004) , microvascular invasion(RR:2.631, P<0.001) and MELD(RR:2.194, P=0.011) are independent factors of patient prognosis.Conclusion: Alphafetoprotein, Eggel’s classification, microvascular invasion and MELD are the independent prognostic factors of HCC patients after LT. More attention should be paid to the influence of MELD on prognosis of HCC patients after LT. |
| Key words: liver neoplasms hepatocellular carcinoma liver transplantation prognosis pathology COX model analysis |
