| Objective: In recent years,patients with hepatocellular carcinoma(HCC)undergoing liver transplantation(LT)have a higher rate of tumor recurrence and metastasis,which seriously affects the efficacy of LT.This paper analyzed the clinical characteristics of tumor recurrence after LT in HCC patients,compared the overall survival and recurrence-free survival rates of LT recipients that meeting the Milan and Hangzhou standards and exceeding the Hangzhou standard,explored the risk factor of tumor recurrence and survival in HCC patients after LT.Methods: The clinical data of 192 patients who underwent allogeneic LT surgery for HCC who were admitted to the Affiliated Hospital of Qingdao University from February 1,2014 to February 29,2020 were collected.There were 170 males(89%)and 22 females(11%);the clinical data collected include: basic patient data,preoperative laboratory examinations,Child-Pugh classification and model for end-stage liver disease(MELD)scores,and whether to perform preoperative down-stage treatment for LT,Whether it meets Milan standard or Hangzhou standard,surgical and postoperative pathological data,etc.The collected clinical data that may be related to recurrence and survival indicators were incorporated into the Cox proportional hazard regression model,and single and multi-factor analysis were performed successively to explore independent risk factors affecting tumor recurrence and survival of HCC patients after LT.Results:(1)Among the 192 HCC patients who underwent LT treatment,62 had tumor recurrence,with a recurrence rate of 32.3%,and a median recurrence time of 6.6(0.2-32.8)months;among them,21 patients(33.9%)had lung metastasis,intrahepatic 16 cases(25.8%)with recurrence,4 cases(6.5%)with bone metastases,2 cases(3.2%)with adrenal metastasis,14 cases(22.6%)with multi-site metastasis,and 5 cases(8.1%)with recurrence site unknown.(2)In this study,the 1-year,2-year,and 3-year recurrence-free survival rates of recipients undergoing LT due to HCC were 77.6%,69.8%,and 67.7%,respectively.Correspondingly,those who met the Milan criteria were 90.0%,83.8% and 83.8%;those meeting the Hangzhou standard were 93.3%,90% and 86.7%;those exceeding the Hangzhou standard were 52.4%,47.6% and 45.1%(P<0.001).In this study,the 1-year,2-year,and 3-year overall survival rates of HCC recipients undergoing LT were 88.0%,79.2%,and 76.0%,respectively;correspondingly,those who met the Milan criteria were 92.5%,88.8%,and 88.8%,86.7%,83.3% and 83.3% meet the Hangzhou standard,and 84.1%,68.3%and 61.0% exceed the Hangzhou standard(P<0.001).This study suggests that the postoperative recurrence-free survival and overall survival rate of LT recipients that meet the Hangzhou criteria are equivalent to those that meet the Milan criteria,and that the postoperative recurrence-free survival and overall survival rates of LT recipients that meet the Milan or Hangzhou criteria are significantly better than those that beyond the Hangzhou standard.(3)AFP≥400ng/m L,invasion of liver capsule,invasion of microvascular or macrovascular are independent risk factors for tumor recurrence after HCC liver transplantation recipients(HR=1.868,1.829,2.978,4.817,all P<0.05).(4)Microvascular invasion and total operation time over 8 hours were independent risk factors for survival of HCC liver transplantation recipients(HR=10.055,2.321;P<0.05)Conclusions:(1)This study suggests that the recurrence rate of hepatocellular carcinoma after liver transplantation was 32.3%,and the common sites of recurrence were lung,liver,bone and adrenal gland.(2)The recurrence-free survival(RFS)and overall survival(OS)of the recipients that meet the Hangzhou criteria are equivalent to those that meet the Milan criteria.The Hangzhou criteria have effectively expanded the selection of liver transplantation recipients,the RFS and OS of the recipients that beyond of Hangzhou standard are significantly reduced,so it should have a certain selectivity for LT receptor.(4)Tumor invasion of microvessels and total operation time ove 8 hours are independent risk factors that affect the survival of HCC patients after LT(HR=10.055,2.321;P<0.05).Tumor invasion of microvessels and total operation time > 8 hours are independent risk factors that affect the survival of HCC patients after LT.(4)Tumor invasion of microvascular and total operation time over 8 hours were independent risk factors for survival of HCC liver transplantation recipients. |
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