摘要
目的总结肝癌患者行肝移植术后复发、转移的治疗方法，探讨其疗效，分析影响复发、转移后生存时间的危险因素。方法本研究回顾性分析1999年1至2011年9月第三军医大学西南医院收治的行肝癌肝移植患者的临床资料。99例患者肝移植术后发生肝癌复发、转移，其中7例因不符合本研究标准予以剔除，最终纳入92例患者的临床资料，根据治疗方案将患者分为单一治疗组（18例）和综合治疗组（74例）。比较两组患者的生存时间，并分析影响肝癌复发、转移患者预后的危险因素。计量资料比较采用t检验，计数资料采用x^2检验或Fisher确切概率法。采用Kaplan—Meier法绘制生存曲线，生存分析采用Log—rank检验，患者预后因素采用多元线性回归分析。结果单一治疗组和综合治疗组患者肝癌复发、转移后生存时间分别为（5．5±1．1）个月和（8．5±1．6）个月，两组比较，差异有统计学意义（Log—rank值为7．489，P〈0．05）。92例患者中，TNM分期Ⅱ期和ⅢA期患者肝癌复发、转移后生存时间为（7．9±1．5）个月，ⅢB期和ⅣA期患者为（7．0±1．3）个月，两者比较，差异有统计学意义（Log—rank值为2．567，P〈0．05）。分化程度：高、中分化患者肝癌复发、转移后生存时间为（8．1±1．5）个月，低分化患者为（7．2±1．4）个月，两者比较，差异有统计学意义（Log—rank值为2．749，P〈0．05）。多元线性回归分析结果表明：肿瘤TNM分期、肿瘤分化程度、是否符合米兰标准、是否合并大血管侵犯是影响患者肝癌复发、转移后生存时间的独立危险因素（t=2．610，3．132，4．378，2．258，P〈0．05）。结论综合治疗可明显延长肝癌复发、转移后患者的生存时间。肝移植术后患者肝癌复发、转移发生时间越早，恶性程度越高，生存时间越短。肿瘤TNM分期、肿瘤分化程度、
Objective To summarize the strategies of treatment and investigate the risk factors affecting the survival of patients with hepatic cancer recurrence and metastasis after liver transplantation. Methods The clinical data of 99 patients with hepatic cancer recurrence and metastasis after liver transplantation who were admitted to the Southwest Hospital of Third Military Medical University from January 1999 to September 2011 were retrospectively analyzed. Of the 99 patients, 7 patients who did not meet the criteria were excluded from the study, and 92 patients were enrolled in the study. All patients were divided into single therapy group （ 18 patients） and combined therapy group （74 patients）. The study was reviewed by the ethics committee, and all the patients signed the informed consent form. The survival time of the 2 groups was compared, and the risk factors affecting the survival time was analyzed. All data were analyzed using the t test, chi-square test or by calculating the Fisher exact probability. The survival curve was drawn using the Kaplan-Meier method, and the survival time was compared by the Log-rank test. Factors influencing the prognosis were analyzed using the multivariate linear regression analysis. Results The survival time of patients in the single therapy group and the combined therapy group after hepatic cancer recurrence and metastasis were （5.5 ± 1.1 ） months and （8.5 ± 1.6） months, respec- tively, with a significant difference between the 2 groups （ Log-rank value = 7. 489, P 〈 0.05 ）. The survival time were （7.9 ± 1.5 ） months for patients in TNM II and m A, and （7.0 ± 1.3 ） months for patients in TNM m B and IVA, with significant difference between the 2 groups （ Log-rank value = 2. 567, P 〈 0.05）. The survival time of patients with moderately or well differentiated tumors after tumor recurrence and metastasis was （8.1 ± 1.5） months, which was significantly longer than （7.2 ± 1.4） months of patients with poorly differentiated tumor （Log
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2012年第6期538-540,共3页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金（81070376）
关键词
肝肿瘤
肝移植
复发
转移
治疗
Liver neoplasms
Liver transplantation
Recurrence
Metastasis
Treatment
