摘要
目的 探讨影响超越加州大学旧金山分校(University of California,San Francisco,UCSF)标准且无大血管侵犯的肝细胞癌(HCC)肝移植患者预后的危险因素.方法 回顾性分析2018年1月至2023年6月34例超UCSF标准且无大血管侵犯的HCC肝移植病例,对预后的影响因素进行分析,采用受试者工作特征曲线评估潜在预后因素的预测效能.结果 移植术后1、3年总体生存率和无瘤生存率分别为94.1％、75.0％和82.4％、38.1％.对最大肿瘤直径、肿瘤数目、移植前AFP、移植前维生素K缺乏或拮抗剂诱导的蛋白质Ⅱ(PIVKA-Ⅱ)以及是否降期进行预后分析,差异有统计学意义(均P＜0.05).联合上述危险因素构建受试者工作特征曲线得到曲线下面积为0.967,灵敏度和特异性分别为0.923和0.952.对分化程度、微血管侵犯和Ki-67进行预后分析,差异有统计学意义(均P＜0.05).联合病理因素构建受试者工作特征曲线得到曲线下面积为0.927,灵敏度和特异性分别为0.769和1.结论 最大肿瘤直径、肿瘤数目、移植前AFP、移植前PIVKA-Ⅱ以及是否经过降期、分化程度、微血管侵犯和Ki-67均影响超UCSF标准且无大血管侵犯的HCC肝移植患者的预后.
Abstract
Objective To investigate the prognostic factors for liver transplantation for hepatocellular carcinoma beyond UCSF criteria but without macrovascular invasion.Methods A retrospective analysis was performed for the clinical data of the hepatocellular carcinoma patients without macrovascular invasion beyond UCSF criteria who underwent liver transplantation at our center from Jan 2018 to Jun 2023.The receiver operating characteristic curve analysis was performed to assess the predictive power of potential prognosis factors.Results With this criteria,the 1-,3-year overall survival rates were 94.1％and 75.0％,respectively,and the 1-,3-year tumor free survival rates were 82.4％and 38.1％,respectively.The maximum tumor size,number of tumors,AFP,PIVKA-Ⅱ before transplantation,and whether undergo pretransplant down-stage therapy were significant prognostic factors(P＜0.05).Combining the above prognostic factors to construct the receiver operating characteristic curve yielded an area under the curve of 0.967,with a sensitivity and specificity of 0.932,0.952,respectively.Further,the differentiation,MVI and Ki-67 were significant prognostic factors(P＜0.05).Combining pathological factors to construct the receiver operating characteristic curve yielded an area under the curve of 0.927,with a sensitivity and specificity of 0.769,1,respectively.Conclusion The maximum tumor diameter,number of tumors,AFP,PIVKA-Ⅱ before transplantation,and pretransplant down-stage therapy and tumor differentiation,MVI and Ki-67 are all prognostic factors of liver transplantation for hepatocellular carcinoma without macrovascular invasion beyond UCSF criteria.
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