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目的:总结肝癌肝移植不同标准适应证的疗效,探讨影响预后的因素。方法:回顾性分析2002年6月至2007年6月96例肝细胞癌肝移植病例,其中符合米兰(Milan)标准者29例,符合加利福尼亚(UCSF)标准者41例,超过UCSF标准者55例。采用Kaplan-Meier法统计分析不同病例入选标准对肝癌肝移植术后生存率及无瘤生存率的影响,并进行Log-rank和Cox多元回归分析。结果:Milan和UCSF标准内影响长期生存的因素包括肿瘤分化、肿瘤部位、镜下癌栓和TNM分期。Milan标准组术后1、2、3、4年总体生存率分别为92.5%、79.6%、79.6%及53.0%,无瘤生存率分别为90.2%、79.3%、76.3%及51.7%;UCSF标准组术后1、2、3、4年总体生存率分别为92.4%、80.9%、73.0及51.1%,无瘤生存率分别为90.2%、79.8%、71.7%及50.2%;超过UCSF标准组术后1、2、3、4年总体生存率分别为66.3%、39.8%、26.5%及15.9%,无瘤生存率分别为64.4%、31.5%、15.8%及15.8%。Milan、UCSF标准组生存率和无瘤生存率与超过UCSF标准组比较有显著差异(P<0.01),Milan标准组与UCSF标准组间生存率和无瘤生存率无显著差异(P>0.05)。结论:与Milan标准相比,UCSF标准显著扩大了肝癌肝移植的适应证范围,更符合作为选择肝癌肝移植病人的标准。
Objective: To summarize the curative effect of different standard indications for liver cancer liver transplantation and to explore the factors that affect the prognosis. Methods: A total of 96 cases of hepatocellular carcinoma (HCC) from June 2002 to June 2007 were retrospectively analyzed. Of them, 29 cases met Milan criteria, 41 cases met the criteria of California (UCSF), 55 cases exceeded UCSF standard . The Kaplan-Meier method was used to analyze the influence of different case selection criteria on the survival rate and tumor-free survival rate of liver cancer patients after liver transplantation. Log-rank and Cox multiple regression analysis were performed. RESULTS: Factors affecting long-term survival within the Milan and UCSF criteria included tumor differentiation, tumor sites, microscopic emboli and TNM staging. The overall survival rates at 1, 2, 3, and 4 years in the Milan standard group were 92.5%, 79.6%, 79.6% and 53.0% respectively, and the tumor-free survival rates were 90.2%, 79.3%, 76.3% and 51.7% The overall survival rates at 1, 2, 3 and 4 years after operation were 92.4%, 80.9%, 73.0 and 51.1% respectively, and the tumor-free survival rates were 90.2%, 79.8%, 71.7% and 50.2% The overall survival rates at 1, 2, 3 and 4 years were 66.3%, 39.8%, 26.5% and 15.9% respectively. The tumor-free survival rates were 64.4%, 31.5%, 15.8% and 15.8% respectively. Milan, UCSF standard group survival rate and tumor-free survival rate were significantly higher than the UCSF standard group (P <0.01), there was no significant difference between the Milan standard group and UCSF standard group survival rate and tumor-free survival rate (P> 0.05) . CONCLUSIONS: Compared with the Milan standard, the UCSF standard significantly expands the range of indications for liver transplantation for liver cancer and is more suitable as a standard for selecting patients with liver cancer who underwent liver transplantation.