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Abstract：
BACKGROUND: In recent years, many studies have attempted to develop models to predict the recurrence of hepatocarcinoma after liver transplantation.
METHODS: A single-centre, retrospective cohort study analysed patients receiving transplants due to hepatocarcinoma during the 20 years of the transplant programme. We analysed patient survival, hepatocarcinoma recurrence and the influence of the different factors described in the literature as related to hepatocarcinoma recurrence. We compared the results of previous items between the first and second decades of the transplantation programme (1995-2010 and 2010-2020).
RESULTS: Of 265 patients, the patient survival rate was 68% at 5 years, 58% at 10 years, 45% at 15 years and 34% at 20 years. The overall recurrence rate of hepatocarcinoma was 14.5%, without differences between periods. Of these, 54% of recurrences occurred early, in the first two years after transplantation. Of the parameters analysed, an alpha-fetoprotein level of >16 ng/mL, the type of immunosuppression used and the characteristics of the pathological anatomy of the explant were significant. A trend towards statistical significance was identified for the number of nodules and the size of the largest nodule. Logistic regression analysis was used to develop a model with a sensitivity of 85.7% and a specificity of 35.7% to predict recurrences in our cohort. Regarding the comparison between periods, the survival and recurrence rates of hepatocarcinoma were similar. The impact of the factors analysed in both decades was similar.
CONCLUSIONS: Most recurrences occur during the first two years post-transplantation, so closer follow-ups should be performed during this period, especially in those patients where the model predicts a high risk of recurrence. The detection of patients at higher risk of recurrence allows for closer follow-up and may, in the future, make them candidates for adjuvant or neoadjuvant systemic therapies to transplantation.
METHODS: A single-centre, retrospective cohort study analysed patients receiving transplants due to hepatocarcinoma during the 20 years of the transplant programme. We analysed patient survival, hepatocarcinoma recurrence and the influence of the different factors described in the literature as related to hepatocarcinoma recurrence. We compared the results of previous items between the first and second decades of the transplantation programme (1995-2010 and 2010-2020).
RESULTS: Of 265 patients, the patient survival rate was 68% at 5 years, 58% at 10 years, 45% at 15 years and 34% at 20 years. The overall recurrence rate of hepatocarcinoma was 14.5%, without differences between periods. Of these, 54% of recurrences occurred early, in the first two years after transplantation. Of the parameters analysed, an alpha-fetoprotein level of >16 ng/mL, the type of immunosuppression used and the characteristics of the pathological anatomy of the explant were significant. A trend towards statistical significance was identified for the number of nodules and the size of the largest nodule. Logistic regression analysis was used to develop a model with a sensitivity of 85.7% and a specificity of 35.7% to predict recurrences in our cohort. Regarding the comparison between periods, the survival and recurrence rates of hepatocarcinoma were similar. The impact of the factors analysed in both decades was similar.
CONCLUSIONS: Most recurrences occur during the first two years post-transplantation, so closer follow-ups should be performed during this period, especially in those patients where the model predicts a high risk of recurrence. The detection of patients at higher risk of recurrence allows for closer follow-up and may, in the future, make them candidates for adjuvant or neoadjuvant systemic therapies to transplantation.
摘要：
背景：近年来，许多研究试图建立预测肝移植后肝癌复发的模型。
方法：单中心，回顾性队列研究分析了20年移植计划期间因肝癌而接受移植的患者.我们分析了病人的生存率,肝癌复发以及文献中描述的与肝癌复发相关的不同因素的影响。我们比较了移植计划的第一个和第二个十年（1995-2010和2010-2020）之间以前项目的结果。
结果：在265名患者中，患者5年生存率为68%,10年时58%,15年为45%，20年为34%。肝癌的总复发率为14.5%,没有不同时期之间的差异。其中,54%的复发发生在早期，移植后的头两年。在分析的参数中，甲胎蛋白水平>16ng/mL，使用的免疫抑制类型和外植体的病理解剖特征是显着的。确定了结节数量和最大结节大小的统计显着性趋势。在我们的队列中，使用Logistic回归分析来建立一个敏感性为85.7％，特异性为35.7％的模型来预测复发。关于期间之间的比较，肝癌的生存率和复发率相似。在这两个十年中分析的因素的影响是相似的。
结论：大多数复发发生在移植后的头两年，所以在此期间应该进行更密切的随访，特别是在那些模型预测复发风险高的患者中。检测到复发风险较高的患者可以进行更密切的随访，在未来,使它们成为移植辅助或新辅助系统疗法的候选者。
方法：单中心，回顾性队列研究分析了20年移植计划期间因肝癌而接受移植的患者.我们分析了病人的生存率,肝癌复发以及文献中描述的与肝癌复发相关的不同因素的影响。我们比较了移植计划的第一个和第二个十年（1995-2010和2010-2020）之间以前项目的结果。
结果：在265名患者中，患者5年生存率为68%,10年时58%,15年为45%，20年为34%。肝癌的总复发率为14.5%,没有不同时期之间的差异。其中,54%的复发发生在早期，移植后的头两年。在分析的参数中，甲胎蛋白水平>16ng/mL，使用的免疫抑制类型和外植体的病理解剖特征是显着的。确定了结节数量和最大结节大小的统计显着性趋势。在我们的队列中，使用Logistic回归分析来建立一个敏感性为85.7％，特异性为35.7％的模型来预测复发。关于期间之间的比较，肝癌的生存率和复发率相似。在这两个十年中分析的因素的影响是相似的。
结论：大多数复发发生在移植后的头两年，所以在此期间应该进行更密切的随访，特别是在那些模型预测复发风险高的患者中。检测到复发风险较高的患者可以进行更密切的随访，在未来,使它们成为移植辅助或新辅助系统疗法的候选者。
