Orthotopic liver transplantation improves postoperative quality of life, survival rate and reduces recurrence rate in patients with liver cancer

Abstract

Objective: To evaluate the impact of orthotopic liver transplantation (OLT) on postoperative quality of life (QoL), survival rate and recurrence rate of patients with liver cancer (LC).

Methods: One hundred and twenty-seven patients with LC treated in our hospital from December 2016 to January 2018 were divided into two groups according to different treatment schemes. Patients in the research group (n=67) were given OLT and those in the control group (n=60 cases) were given hepatectomy. The incidence of postoperative complications, hospitalization expenses, the time to liver function recovery, surgical wound healing, pain resolution and hospitalization were compared between the two groups. The overall survival rate (OSR), disease-free survival rate (DFSR), and average survival time of patients were recorded and compared. The Visual Analogue Scale (VAS) score one day and three days after surgery, alpha-fetoprotein (AFP) level, and adverse emotion before and after operation were compared. QoL scores at six months after surgery, one-year recurrence and metastasis rates, and treatment satisfaction one year after surgery were also compared. The expression of Ki-67 and Topo IIαin the tumor-bearing group (n=5) was detected.

Results: The research group presented markedly lower incidence of postoperative complications, and evidently shorter time to liver function recovery, surgical wound healing, pain resolution and hospitalization, while with noticeably higher hospitalization expenses. The one-year and five-year OSRs and DFSRs were noticeably higher, and the average survival time was remarkably longer in the research group as compared to the control group. Patients in the research group scored remarkably lower in VAS scores on the first and third day after surgery than patients in the control group. In comparison with the control group, the one-year recurrence and metastasis rates were evidently lower in the research group, and the scores of SF-36 were remarkably higher. The AFP level at one month after surgery was obviously lower in the research group, and the treatment satisfaction was greatly higher. Ki-67 in the tumor-bearing group was mainly located in the nucleus, and Topo IIα was mainly nucleus positive; the positive Ki-67 and Topo IIα expression rates in the tumor-bearing group was 66.7% and 69.8%, respectively.

Conclusions: OLT can improve the postoperative QoL, survival rate and reduce the recurrence rate of LC patients.

Keywords: Orthotopic liver transplantation; liver cancer; quality of life; recurrence rate; survival rate.

Figure 1

Comparison of VAS scores. VAS scores of patients in the research group were significantly lower than those in the control group on the 1st and 3rd day after operation. Note: ***P<0.001.

Figure 2

Comparison of SF-36 scores. Six months after operation, the scores of general health (A), physical functioning (B), role-physical (C), bodily pain (D), vitality (E), social functioning (F), role-emotional (G) and mental health (H) of patients in the research group were significantly higher than those in the control group. Note: ***P<0.001.

Figure 3

Comparison of SAS and SDS scores. After surgical treatment, SAS scores (A) and SDS scores (B) of patients in the two groups decreased significantly, and the scores in the research group were significantly lower than those in the control group. Note: ***P<0.001.

Figure 4

Comparison of AFP level. One month after surgery, the AFP level of patients in both groups decreased significantly, and the AFP level in the research group was significantly lower than that in the control group. Note: ***P<0.001.

Figure 5

Expression of Ki-67 and Topo IIα in tumor-bearing group. A. Expression of Ki-67; B. Expression of Topo IIα (50 μm) (3 cases were from OLT group and 2 cases were from control group).