Treatment of hepatic cancer recurrence and metastasis after liver transplantation

Objective To summarize the strategies of treatment and investigate the risk factors affecting the survival of patients with hepatic cancer recurrence and metastasis after liver transplantation.Methods The clinical data of 99 patients with hepatic cancer recurrence and metastasis after liver transplantation who were admitted to the Southwest Hospital of Third Military Medical University from January 1999 to September 2011 were retrospectively analyzed.Of the 99 patients,7 patients who did not meet the criteria were excluded from the study,and 92 patients were enrolled in the study.All patients were divided into single therapy group (18 patients) and combined therapy group (74 patients).The study was reviewed by the ethics committee,and all the patients signed the informed consent form.The survival time of the 2 groups was compared,and the risk factors affecting the survival time was analyzed.All data were analyzed using the t test,chi-square test or by calculating the Fisher exact probability.The survival curve was drawn using the Kaplan-Meier method,and the survival time was compared by the Log-rank test.Factors influencing the prognosis were analyzed using the multivariate linear regression analysis.Results The survival time of patients in the single therapy group and the combined therapy group after hepatic cancer recurrence and metastasis were (5.5 ± 1.1) months and (8.5 ± 1.6) months,respectively,with a significant difference between the 2 groups (Log-rank value =7.489,P ＜ 0.05).The survival time were (7.9 ± 1.5) months for patients in TNM Ⅱ and Ⅲ A,and (7.0 ± 1.3) months for patients in TNM Ⅲ B and ⅣA,with significant difference between the 2 groups (Log-rank value =2.567,P ＜0.05).The survival time of patients with moderately or well differentiated tumors after tumor recurrence and metastasis was (8.1 ± 1.5) months,which was significantly longer than (7.2 ± 1.4)months of patients with poorly differentiated tumor (Log-rank value =2.749,P ＜ 0.05).TNM stage,tumor differentiation,Milan criteria,great vessel invasion were independent factors affecting the survival of patients with hepatic cancer recurrence and metastasis (t =2.610,3.132,4.378,2.258,P ＜ 0.05).Conclusions Combined therapy can significantly prolong the survival time of patients with hepatic cancer recurrence and metastasis.Earlier hepatic cancer recurrence and metastasis after liver transplantation result in a shorter survival time.TNM stage,tumor differentiation,great vessel invasion and Milan criteria are risk factors affecting the survival of patients with hepatic cancer recurrence and metastasis after liver transplantation. Key words: Liver neoplasms ;  Liver transplantation ;  Recurrence ;  Metastasis ;  Treatment