摘要目的 评价原发性肝癌患者行肝移植的预后情况,并分析其预后相关的影响因素.方法 回顾性分析首都医科大学附属北京朝阳医院2013年1月至2017年12月298例行同种异体肝移植患者资料,依据纳入和排除标准最终入选121 例,其中男性108 例,女性13 例,年龄31 ～70 (52. 7 ± 8. 7)岁.收集和分析患者病历资料并随访预后情况. Kaplan-Meier法绘制生存曲线,生存率比较采用log-rank检验.多因素Cox回归分析预后影响因素.结果 121例原发性肝癌肝移植患者围手术期死亡5例(4. 1% ).截止随访结束,共115例(95. 0% )患者获得随访.获得随访的患者术后1、2、3年生存率分别为81. 0% 、74. 6%和70. 2% ,中位生存时间是41. 5个月.多因素分析显示,术前Child分级( RR =3. 028,95% CI:1. 625 ～5. 643)和微血管侵犯( RR =7. 165,95% CI:2. 237 ～22. 951)是原发性肝癌肝移植患者预后的独立危险因素.术前Child分级越高患者预后越差,微血管侵犯的患者预后较差.结论 原发性肝癌患者行肝移植预后较好.术前Child分级和有微血管侵犯是原发性肝癌肝移植患者预后的独立危险因素.

abstractsObjective To evaluate the prognosis and related risk factors in patients with primary liver cancer after liver transplantation. Methods We retrospectively analyzed the clinical data of 298 patients who underwent liver transplantation between January 2013 and December 2017 at Beijing Chaoyang Hospital of Capital Medical University. 121 patients with primary liver cancer on postoperative pathological diagnosis were included into this study. The patients included 108 males and 13 females, aged from 31 to 70 years, with an average of (52. 7 ± 8. 7) years. The prognosis and the related risk factors on prognosis were analyzed. The survival curve was drawn by the Kaplan-Meier method, and the survival rate was compared by the log-rank test. Multivariate Cox regression was used to analyze the prognostic factors. Results Of the 121 patients who were enrolled in this study, 5 patients died during the perioperative period, making a perioperative mortality rate of 4. 1% (5/121). The remaining 115 patients were followed up and the followed up rate was 95. 0% (115/121). The overall 1-, 2- and 3-year survival rates were 81. 0% , 74. 6% and 70. 2% , respectively. The median survival was 41. 5 months. Multivariate analysis showed that preoperative Child grading (RR=3. 028, 95% CI: 1. 625～5. 643) and microvascular invasion (RR=7. 165, 95% CI: 2. 237～22. 951) were independent risk factors of prognosis. The worse the preoperative Child grading, the worse was the prognosis. The prognosis of patients with microvascular invasion was also poor. Conclusions The overall prognosis of patients with primary liver cancer after liver transplantation was good. Preoperative Child grading and pathological microvascular invasion were the main risk factors of prognosis after liver transplantation carried out for primary liver cancer.