Center for Organ and Cell Transplantation, Scripps Clinic, San Diego, CA, USA.
Transpl Int. 2013 Jul;26(7):734-9. doi: 10.1111/tri.12117. Epub 2013 May 23.
Hepatocellular carcinoma (HCC) is increasing in incidence, resulting in approximately 35% of orthotopic liver transplantation (OLT) performed each year. Sorafenib (SOR) is a multi-kinase inhibitor that is approved for the treatment of unresectable HCC. Concerns have been raised regarding the safety of SOR in patients undergoing major surgery. We retrospectively reviewed 79 consecutive patients with HCC receiving OLT. Patient data were compared for those who received SOR pre-OLT with those who did not. SOR was continued until time of transplant. During this time period, 15 patients received SOR pre-OLT and 64 did not. The two groups were similar with regards to demographic and clinical data. SOR patients were more likely to have larger tumors, more tumor nodules, and be outside of Milan criteria. The rate of recurrence of HCC was not different between the groups (13% in SOR group, 11% in no-SOR group). Surgical complications were not increased in patients receiving SOR prior to OLT. Survival rate was also similar between the two groups (median follow-up 19.7 months). In this small cohort of patients, use of SOR prior to liver transplantation does not confer an increased risk of surgical complications, even when continued until the day of surgery.
肝细胞癌 (HCC) 的发病率正在增加，导致每年约有 35%的原位肝移植 (OLT) 是为治疗 HCC 而进行的。索拉非尼 (SOR) 是一种多激酶抑制剂，已被批准用于治疗不可切除的 HCC。人们对 SOR 在接受大手术的患者中的安全性表示担忧。我们回顾性分析了 79 例连续接受 OLT 的 HCC 患者。比较了接受 OLT 前接受 SOR 治疗和未接受 SOR 治疗的患者的数据。SOR 一直持续到移植时。在此期间，有 15 例患者接受了 SOR 治疗，64 例患者未接受 SOR 治疗。两组在人口统计学和临床数据方面相似。SOR 组患者的肿瘤更大、肿瘤结节更多，且超出米兰标准。两组 HCC 复发率无差异（SOR 组 13%，无 SOR 组 11%）。OLT 前接受 SOR 治疗的患者手术并发症发生率并未增加。两组的生存率也相似（中位随访 19.7 个月）。在这一小部分患者中，OLT 前使用 SOR 并不会增加手术并发症的风险，即使一直持续到手术当天。
