Stippel D L, Kasper H U, Schleimer K, Töx U, Bangard C, Hölscher A H, Beckurts K T E
Department of Visceral and Vascular Surgery, University of Cologne, Joseph Stelzmann Strasse 9, 50931 Köln, Germany.
Transplant Proc. 2005 Jun;37(5):2185-7. doi: 10.1016/j.transproceed.2005.03.013.
This 44-year-old woman developed multifocal hepatocellular carcinoma (HCC) within hepatitis B-induced liver cirrhosis. At the time of listing for transplantation the HCC had progressed beyond the Milan criteria. Due to her young age, high grade of histological differentiation according to biopsy, and lack of therapeutic alternatives, she was listed for transplantation. She received an organ from the Eurotransplant marginal liver list. Immunosuppression was reduced to tacrolimus monotherapy within 4 months. Five months after transplantation bilateral bulky ovarian metastases were seen on computed tomography (CT) scan. A bilateral salphingo-oophorectomy was performed and immunosuppression switched to sirolimus monotherapy. Fourteen months after this procedure and 19 months after transplantation, the patient is asymptomatic with stable liver function. She is free of recurrence as judged by CT scan, bone scan, and alpha-fetoprotein. In conclusion, radical surgical treatment and immunosuppression using sirolimus may achieve tumor-free survival in selected patients with advanced or recurrent HCC.
这位44岁的女性在乙型肝炎引起的肝硬化基础上发展为多灶性肝细胞癌（HCC）。在列入移植名单时，HCC已进展至超出米兰标准。由于她年轻、活检显示组织学分化程度高且缺乏治疗选择，她被列入移植名单。她接受了来自欧洲移植边缘肝脏名单的器官。免疫抑制在4个月内减至仅用他克莫司治疗。移植后5个月，计算机断层扫描（CT）显示双侧卵巢有巨大转移瘤。进行了双侧输卵管卵巢切除术，免疫抑制改为仅用西罗莫司治疗。在此手术后14个月以及移植后19个月，患者无症状，肝功能稳定。经CT扫描、骨扫描和甲胎蛋白判断，她无复发迹象。总之，对于部分晚期或复发性HCC患者，根治性手术治疗及使用西罗莫司进行免疫抑制可能实现无瘤生存。
