Analysis Of Risk Factors For Tumor Recurrence And Prognosis After Liver Transplantation For Hepatocellular Carcinoma

ObjectivesTo analyze risk factors for tumor recurrence and prognosis of98hepatocellular carcinoma consecutive patients after liver transplantation(LT)Meterials and MethodsThe clinical and follow-up data of98consecutive patients who underwent liver transplantation for HCC between July2007and December2012in the liver transplantation centrals of Shanghai Jiaotong University affiliated First People’s Hospital and Shandong University affiliated Shandong Qianfoshan Hospital were analyzed retrospectively. There were90males (91.84%) and8females (8.16%).with a median of50yr (range,21yr to64yr). The collected data of clinical factors included age,sex, the pre-operative alpha-fetoprotein (AFP) level, surgical approaches,pre-transplant local treatments(radiofrequency ablation,percutaneous ethanol injection,transarterial chemoembolization),disease causes (HBV or not),tumor number, diameter of main tumor, macrovacular invasion and microvascular invasion, Immunosuppression regimen.All the patients took review of liver function, AFP level and FK506concentration monthly after liver transplantation. At the same time,the patients took B-type ultrasound,chest X-ray,CT every two months,if necessary PT-CT, in order to montor and inspect the post-operative recovery and tumor recurrence of the patients.The follow-up study lasted until31December,2013.The Kaplan-meier method was used to evaluate the cumulative survival rate. Log-rank test and Cox regression model were performed to analyze clinical pathologic risk factors by univariate and multivariate analysis respectively. ResultsDuring the follow-up period,there are35patients(35.71%) who were tumor recurrence(range2months to49months,a medien time of7months).6-month,one-yr two-yr and3-yr disease free survival rates of these patients were78.5%,67.0%,50.5%and35.0%, respectively. During the follow-up period,there are31patients(31.63%) died with tumor recurrence(n=29) or other causes.In these patents,29patients died with tumor recurrence.6-month,one-yr two-yr and3-yr overall survival rates of patients were91.0%,78.5%,52.5%and36.5%, respectively.The univariate analysis showed that tumor number (≥2), diameter of main tumor, macrovacular invasion and microvascular invasion were found to be associated with the disease free survival rate and the overall survival rate significantly(P<0.05). In the multivariate analysis, the diameter of main tumor(>5cm) was the most independent, statistical and significant factor affecting disease survival and overall survival(P<0.05). Statistical analysis was performed using SPSS16.0(Chicago, USA).ConclusionsThe diameter of main tumor(>5cm) is the most independent and major risk factor for tumor recurrence and prognosis.At the same time, tumor number, macrovacular invasion and microvascular invasion are also significant but not independent risk factors, maybe that is the result of interacting of these three factors.