Risk Factors And Analysis Of Tumor Recurrence After Liver Transplantation In Patients With Hepatitis B-related Liver Cancer

ObjectiveTo explore the risk factors and prognosis of 91 patients with hepatitis B-related liver cancer who had tumor recurrence after liver transplantation.MethodsRetrospective analysis of clinical data from 91 patients with orthotopic liver transplantation for hepatitis B-related liver cancer at the First Affiliated Hospital of Zhengzhou University from January 1,2013 to December 31,2015.There were 77males(84.6%)and 14 females(15.4%).The general clinical data collected included gender,age,hepatitis virus copy number,total bilirubin,neutrophil lymphocyte ratio,platelet lymphocyte ratio,prothrombin time,international normalized ratio,preoperative downgrade treatment,Child-Pugh classification,microvascular invasion,TNM stage,maximum tumor diameter,number of tumors,preoperative alpha fetoprotein,intraoperative suspension of red blood cell input,postoperative tumor pathology grades,etc.The Log-Rank test method was used to analyze the clinical data collected above by univariate analysis.The Cox proportional hazard regression model was used to analyze the statistically significant factors in the univariate analysis.P<0.05 was considered statistically significant.The effects of significant statistical differences in Cox multivariate analysis on the overall survival rate and tumor-free survival of liver cancer patients with liver transplantation at 1 year,2 years,and 3 years after surgery were compared.ResultsA total of 35 patients with hepatitis B-related liver cancer had recurrence after liver transplantation.The recurrence rate was 38.5%,the recurrence time was 3-33months,the median time to recurrence was 10 months,and the recurrence sites included liver(16.5%),lung(16.5%),bone(4.4%)and retroperitoneal lymph nodes(1.1%).28 patients died during the follow-up period,and the mortality rate was30.8%.The overall survival rates of patients at 1 year,2 years,and 3 years after transplantation were 91%,80%,and 69%,respectively.The tumor-free survival rates of patients at 1 year,2 years,and 3 years after surgery were79%,67%,62%,respectively.Univariate analysis showed that the amount of hepatitis B virus DNA(χ~2=10.358,P=0.001),platelet/lymphocyte ratio(χ~2=5.871,P=0.015),alpha-fetoprotein level(χ~2=6.568,P=0.010),microvascular invasion(χ~2=12.300,P<0.001),TNM stage(χ~2=8.262,P=0.016),tumor diameter(χ~2=19.222,P<0.001),postoperative pathological grade(χ~2=7.754,P=0.021)before surgery were the risk factors for tumor recurrence after liver transplantation in patients with hepatitis B-relatedlivercancer.Coxmultivariateregressionshowedthat alpha-fetoprotein≥400ng/ml and tumor diameter>5cm were independent risk factors for tumor recurrence after liver transplantation in patients with hepatitis B related liver cancer.ConclusionsPreoperative alpha-fetoprotein≥400ng/ml and tumor diameter>5cm are independent risk factors for tumor recurrence after liver transplantation in patients with hepatitis B-related liver cancer.