Clinical efficacy and prognostic factors of salvage liver transplantation for postoperative recurrence of primary liver cancer

doi:10.3877/cma.j.issn.2095-3232.2021.04.006

Abstract

Abstract:

Objective

To evaluate the clinical efficacy and to explore the prognostic factors of salvage liver transplantation (SLT) for postoperative recurrence of primary liver cancer.

Methods

Clinical data of 273 patients with primary liver cancer who underwent liver transplantation in Huashan Hospital Affiliated to Fudan University from May 2014 to October 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 252 patients were male and 21 female, aged (51±9) years on average. According to different surgical methods, 196 patients undergoing primary liver transplantation were assigned into the PLT group and 77 patients receiving SLT due to postoperative recurrence after radical resection were allocated into the SLT group. The perioperative conditions and incidence of complications were statistically compared between two groups. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The independent influencing factors of postoperative prognosis of SLT patients were analyzed by Cox proportional hazards regression model.

Results

After propensity score matching of baseline data at a ratio of 1:1, 70 patients were assigned into each group. In the SLT group, the operation time was (479±106) min, significantly longer than (438±79) min in the PLT group (t=2.587, P<0.05). The perioperative mortality rate in the SLT group was 11%(8/70), which did not significantly differ from 6%(4/70) in the PLT group (χ²=1.458, P>0.05). The 1-, 3-, 5-year overall survival rates were 85.7%, 75.0%, 63.3% in the SLT group and were 88.3%, 79.0%, 70.3% in the PLT group, respectively. The 1-, 3-, 5-year tumor-free survival rates were 98.4%, 72.2%, 57.1% in the SLT group, and were 92.5%, 74.3%, 54.7% in the PLT group, respectively. The overall survival and tumor-free survival rates did not significantly differ between two groups (χ²=1.627, 0.265; P>0.05). Multivariate analysis demonstrated that AFP >200 μg/L and the maximal tumor diameter >3 cm were the independent risk factors for postoperative overall survival of SLT patients (HR=2.630, 3.082; P<0.05), which were also the independent risk factors for postoperative tumor-free survival (HR=5.965, 3.166; P<0.05).

Conclusions

SLT is a safe and reliable treatment for postoperative recurrence of primary liver cancer, which can yield equivalent clinical efficacy to PLT. AFP and tumor diameter are the independent risk factors for the postoperative prognosis of SLT patients.

Key words: Liver neoplasms, Liver transplantation, Treatment outcome, Risk factors

Tuo Chen, Quanbao Zhang, Yifeng Tao, Conghuan Shen, Ruidong Li, Zhenyu Ma, Jianhua Li, Lu Lu, Jinhong Chen, Lunxiu Qin, Zhengxin Wang. Clinical efficacy and prognostic factors of salvage liver transplantation for postoperative recurrence of primary liver cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(04): 365-370.

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References 30

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参数		PSM前				PSM后
参数		PLT组	SLT组	统计值	P值	PLT组	SLT组	统计值	P值
性别（例，男/女）		183/13	69/8	χ²=1.099	0.295	63/7	64/6	χ²=0.085	0.771
年龄（岁，±s）		51±9	50±9	t=0.924	0.357	52±9	51±9	t=0.181	0.857
BMI（kg/m²，±s）		24±4	24±5	t=-0.155	0.877	24±5	25±5	t=-0.424	0.672
MELD评分（分，±s）		32±12	29±11	t=2.259	0.025	29±10	29±11	t=-0.109	0.913
术前辅助治疗（例）		37	34	χ²=18.357	<0.001	28	27	χ²=0.030	0.863
AFP >200 μg/L（例）		70	19	χ²=3.066	0.080	17	19	χ²=0.150	0.699
乙型病毒性肝炎（例）		175	73	χ²=2.024	0.155	66	66	χ²=0	1.000
Child-Pugh分级（例）				χ²=4.405	0.111			χ²=1.234	0.540
	A级	15	11			6	7
	B级	43	21			15	10
	C级	138	45			49	53
腹腔积液（例）		96	31	χ²=1.690	0.194	31	30	χ²=0.029	0.865
米兰标准（例）		81	25	χ²=1.827	0.177	24	23	χ²=0.032	0.858
UCSF标准（例）		95	33	χ²=0.699	0.403	33	30	χ²=0.260	0.610
杭州标准（例）		145	63	χ²=1.872	0.171	59	56	χ²=0.438	0.508
肿瘤数目（例）				χ²=6.511	0.039			χ²=4.500	0.105
	1个	108	32			40	31
	1～3个	53	21			20	19
	>3个	35	24			10	20
微血管侵犯（例）		151	59	χ²=0.005	0.941	51	54	χ²=0.343	0.558
肿瘤最大径>3 cm（例）		113	37	χ²=2.059	0.151	43	35	χ²=1.853	0.173
肿瘤中低分化（例）		81	37	χ²=1.019	0.313	26	35	χ²=2.353	0.125

参数		PSM前				PSM后
参数		PLT组	SLT组	统计值	P值	PLT组	SLT组	统计值	P值
性别（例，男/女）		183/13	69/8	χ²=1.099	0.295	63/7	64/6	χ²=0.085	0.771
年龄（岁，±s）		51±9	50±9	t=0.924	0.357	52±9	51±9	t=0.181	0.857
BMI（kg/m²，±s）		24±4	24±5	t=-0.155	0.877	24±5	25±5	t=-0.424	0.672
MELD评分（分，±s）		32±12	29±11	t=2.259	0.025	29±10	29±11	t=-0.109	0.913
术前辅助治疗（例）		37	34	χ²=18.357	<0.001	28	27	χ²=0.030	0.863
AFP >200 μg/L（例）		70	19	χ²=3.066	0.080	17	19	χ²=0.150	0.699
乙型病毒性肝炎（例）		175	73	χ²=2.024	0.155	66	66	χ²=0	1.000
Child-Pugh分级（例）				χ²=4.405	0.111			χ²=1.234	0.540
	A级	15	11			6	7
	B级	43	21			15	10
	C级	138	45			49	53
腹腔积液（例）		96	31	χ²=1.690	0.194	31	30	χ²=0.029	0.865
米兰标准（例）		81	25	χ²=1.827	0.177	24	23	χ²=0.032	0.858
UCSF标准（例）		95	33	χ²=0.699	0.403	33	30	χ²=0.260	0.610
杭州标准（例）		145	63	χ²=1.872	0.171	59	56	χ²=0.438	0.508
肿瘤数目（例）				χ²=6.511	0.039			χ²=4.500	0.105
	1个	108	32			40	31
	1～3个	53	21			20	19
	>3个	35	24			10	20
微血管侵犯（例）		151	59	χ²=0.005	0.941	51	54	χ²=0.343	0.558
肿瘤最大径>3 cm（例）		113	37	χ²=2.059	0.151	43	35	χ²=1.853	0.173
肿瘤中低分化（例）		81	37	χ²=1.019	0.313	26	35	χ²=2.353	0.125

组别	例数	围手术期死亡	感染	肾衰竭	急性排斥反应	胆道并发症	血管并发症	移植物丢失
SLT组	70	8	6	1	8	3	2	2
PLT组	70	4	4	0	10	9	3	2
χ²值		1.458	0.431	-	0.255	3.281	0	0
P值		0.227	0.512	1.000	0.614	0.070	1.000	1.000

组别	例数	围手术期死亡	感染	肾衰竭	急性排斥反应	胆道并发症	血管并发症	移植物丢失
SLT组	70	8	6	1	8	3	2	2
PLT组	70	4	4	0	10	9	3	2
χ²值		1.458	0.431	-	0.255	3.281	0	0
P值		0.227	0.512	1.000	0.614	0.070	1.000	1.000

参数	总体生存			无瘤生存
参数	HR	95%CI	P值	HR	95%CI	P值
AFP>200 μg/L	2.630	1.122～6.166	0.026	5.965	2.397～14.844	<0.001
肿瘤最大径>3 cm	3.082	1.285～8.181	0.013	3.166	1.252～8.005	0.015

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