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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。
Objective: To evaluate the clinicopathological features of hepatocellular carcinoma (HCC) on the prognosis of liver transplantation. Methods: The clinical data of 272 patients with hepatocellular carcinoma who underwent liver transplantation were retrospectively analyzed. The survival rate was calculated by the life table method. The cumulative survival rate was calculated by Kaplan-Meier method. The survival curves were compared by Log-rank test. COX proportional hazards regression model for univariate and multivariate analysis. Results: Univariate analysis indicated that the clinical and pathological factors affecting the prognosis of HCC include MELD, AFP, tumor size, invasive capsule, Eggel’s classification, microvessel invasion, lymph node metastasis and TNM staging. Multivariate analysis Eggel’s classification (RR: 1.617, P = 0.004), microvessel infiltration (RR: 2.631, P <0.001) and MELD (RR: 2.194, P = 0.011) Independent prognostic factor. CONCLUSION: Alpha-fetoprotein, Eggel’s classification, microvascular infiltration and MELD are independent prognostic factors for HCC. The impact of MELD on the prognosis of adult hepatocellular carcinoma should be considered clinically.