|本期目录/Table of Contents|

符合米兰标准的老年肝癌肝移植受者的预后评价:一项基于SEER数据库的回顾性研究

《现代肿瘤医学》[ISSN:1672-4992/CN:61-1415/R]

期数:
2019年20期
页码:
3652-3656
栏目:
论着(消化·泌尿系肿瘤)
出版日期:
2019-09-08

文章信息/Info

Title:
Clinical outcomes of liver transplantation for the elderly recipient with hepatocellular carcinoma meeting Milan criteria:a retrospective study based on SEER database
作者:
余 斌1;?2;?丁佑铭1;?2;?廖晓锋3;?汪 斌1;?2;?陈晓燕1;?2
1.武汉大学人民医院肝胆腔镜外科,湖北 武汉 430060;2.消化系统疾病湖北省重点实验室,湖北 武汉 430060;3.襄阳市中心医院普外科,湖北 襄阳 441021
Author(s):
Yu Bin1;?2;?Ding Youming1;?2;?Liao Xiaofeng3;?Wang Bin1;?2;?Chen Xiaoyan1;?2
1.Department of Hepatobiliary and Laparoscopic Surgery,Renmin Hospital of Wuhan University,Hubei Wuhan 430060,China;2.Hubei Key Laboratory of Digestive System Disease,Hubei Wuhan 430060,China;3.Department of General Surgery,Xiangyang Central Hospital,Hubei Xiangyang 441021,China.
关键词:
肝细胞癌;?肝移植;?受者年龄;?预后
Keywords:
hepatocellular carcinoma;?liver transplantation;?recipient age;?prognosis
分类号:
R735.7
DOI:
10.3969/j.issn.1672-4992.2019.20.023
文献标识码:
A
qq自动领红包软件:
目的:探讨符合米兰标准的老年(>65岁)肝癌肝移植受者的远期预后。方法:基于美国SEER数据库2004年至2015年间801例符合米兰标准的肝癌肝移植受者的临床数据,利用Kaplan-Meier法比较老年组(>65岁,94例)与青年组(18~65岁,707例)肝移植术后的总体生存率(overall survival,OS)和肝癌特异生存率(liver cancer specific survival,LCSS)。Cox比例风险模型用于分析影响肝癌肝移植受者预后的危险因素。结果:符合米兰标准的老年(66~75岁组、>75岁组)肝癌患者肝移植治疗占比(14.4%、0.2%)显着低于青年肝癌患者(30.3%)(P<0.05)。肝癌肝移植受者的中位年龄逐年增加,其由2004年至2006年间的55.0岁渐增至2013年至2015年间的60.0岁(P<0.05)。Kaplan-Meier分析提示青年组OS优于老年组(1、3、5、10年OS,93.5%、83.3%、77.9%、64.0% vs 91.2%、80.8%、66.4%、46.6%,P<0.05),但二者LCSS无异(1、3、5、10年LCSS,97.5%、91.9%、88.8%、82.7% vs 97.7 %、89.4%、78.1%、73.9%,P>0.05)。多因素Cox回归分析提示受者年龄、肿瘤分化程度是影响肝癌肝移植受者OS的独立危险因素(均P<0.05),而肿瘤分化程度、微血管浸润则是影响肝癌肝移植受者LCSS的独立危险因素(均P<0.05)。结论:受者年龄并不是肝癌肝移植远期预后的良好预测指标;经严格筛选的老年(>65岁)肝癌肝移植受者有机会获得与青年肝癌肝移植受者相近的预后。
Abstract:
Objective:To evaluate the impact of recipient age exceeding 65 years on the long-term survival outcomes after LT meeting Milan criteria.Methods:Using the Surveillance,Epidemiology,and End Results database,a total of 801 HCC patients meeting Milan criteria underwent LT were enrolled from 2004 to 2015.Overall survival (OS) and liver cancer-specific survival (LCSS) comparisons were conducted between the elderly group (>65 years,n=94) and young group (18~65 years,n=707).Cox's proportional hazard model was used to evaluate the prognosis-relative factors.Results:The results demonstrated that the elderly HCC patientswere less likely to undergo LT (14.4%、0.2%) as their initial treatments compared to the younger HCC patients meeting criteria (30.3%)(P<0.05).A trend toward the gradual increase in median patient age (from 55.0 to 60.0 years) in the study period was observed during 2004-2015 (P<0.05).Kaplan-Meier analyses revealed that younger group had better OS than the elderly group (1-,3-,5-,10-year OS,93.5%,83.3%,77.9%,64.0% vs 91.2%,80.8%,66.4%,46.6%,P<0.05),butno significant difference was observed between the two groups in terms of LCSS(1-,3-,5-,10-year LCSS,97.5%,91.9%,88.8%,82.7% vs 97.7 %,89.4%,78.1%,73.9%,P>0.05).Multivariate Cox proportional hazards regression model showed that recipient age,tumor differentiation were the independent predictors of OS,and tumor differentiation and microvascular invasion were the independent predictors of LCSS (all P< 0.05).Conclusion:Chronologic age is not a good predictor of the outcome of liver transplantation.Carefully selected elderly HCC recipients can achieve similar long-term survival outcomes with the younger HCC recipients if overall clinical conditions and comorbidities allow.

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备注/Memo

备注/Memo:
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更新日期/Last Update: 1900-01-01