Farinati F, Salvagnini M, de Maria N, Fornasiero A, Chiaramonte M, Rossaro L, Naccarato R
Divisione di Gastroenterologia, Policlinico Universitario, Padova, Italy.
J Hepatol. 1990 Nov;11(3):297-301. doi: 10.1016/0168-8278(90)90211-9.
The liver is an estrogen responsive organ. Clinically, estrogens may play a role in the induction of liver tumors and, experimentally, estrogens are involved in the control of hepatocyte proliferation. The results of a prospective controlled clinical trial using an anti-estrogen, tamoxifen, in patients with unresectable hepatocellular carcinoma (HCC) are presented below. Thirty-eight consecutive cirrhotics with HCC were allocated to either 30 mg/day tamoxifen or no treatment. The two groups of patients were matched for mean age, male/female ratio, Child-Pugh risk group, approximate tumor volume (US and/or CT scan) and etiology of the underlying cirrhosis. The drug appeared to have no side effects. Survival was significantly prolonged in tamoxifen-treated patients with 22% (vs. 5%) survival at 12 months. No differences were observed between males and females or alcoholic and non-alcoholic cirrhosis. In 53% of tamoxifen-treated patients the levels of alpha-fetoprotein dropped and, in this subgroup, survival was further prolonged. Tumor volume, lactate dehydrogenase (LDH) and alkaline phosphatase slowly increased, suggesting a slower, but continuous, progression of the disease. In conclusion, anti-estrogen treatment appears effective in the palliation of unresectable or otherwise untreatable HCC. A reduction in alpha-fetoprotein levels appears to be a favorable prognostic index.
肝脏是一个对雌激素有反应的器官。在临床上，雌激素可能在肝肿瘤的诱发中起作用，并且在实验中，雌激素参与肝细胞增殖的控制。以下展示了一项针对不可切除肝细胞癌（HCC）患者使用抗雌激素药物他莫昔芬的前瞻性对照临床试验结果。38例连续的HCC肝硬化患者被分配至每天服用30毫克他莫昔芬组或不治疗组。两组患者在平均年龄、男女比例、Child-Pugh风险组、大致肿瘤体积（超声和/或CT扫描）以及潜在肝硬化病因方面相匹配。该药物似乎没有副作用。他莫昔芬治疗组患者的生存期显著延长，12个月时生存率为22%（相比之下未治疗组为5%）。在男性和女性之间以及酒精性和非酒精性肝硬化患者之间未观察到差异。在53%接受他莫昔芬治疗的患者中，甲胎蛋白水平下降，并且在该亚组中，生存期进一步延长。肿瘤体积、乳酸脱氢酶（LDH）和碱性磷酸酶缓慢升高，提示疾病进展较慢但持续。总之，抗雌激素治疗似乎对不可切除或其他无法治疗的HCC的姑息治疗有效。甲胎蛋白水平降低似乎是一个有利的预后指标。
