单中心经验：移植后辅助化疗影响肝癌患者的预后。

A single center experience: post-transplantation adjuvant chemotherapy impacts the prognosis of hepatocellular carcinoma patients.

机构信息

Department of General Surgery, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai 200080, China.

Department of General Surgery, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai 200080, China. Email:

出版信息

Chin Med J (Engl). 2014;127(3):430-4.

DOI:

PMID:24451946

Abstract

BACKGROUND

The aim of this research was to investigate the impact of post-transplantation adjuvant chemotherapy in the prevention of tumor recurrence and metastasis for hepatocellular carcinoma (HCC) exceeding Milan criteria after liver transplantation.

METHODS

A total of 117 patients with HCC exceeding the Milan criteria who had undergone orthotopic liver transplantation (OLT) from August 2002 to February 2009 were enrolled and retrospectively analyzed. The patients were divided into four groups according to chemotherapy regimens and the impact of different chemotherapy regimens on survival, disease-free survival, and adverse effects were compared.

RESULTS

One year survival rates for the gemicitabine, conventional chemotherapy, oxaliplatin plus capecitabine and the best supportive care (BSC) group were 87.5%, 84.2%, 81.6%, and 67.5%. The 3-year survival rates were 48.1%, 25.9%, 31.6%, and 33.7%, respectively for the four groups. One year disease free survival rates for the four groups were 69.8%, 47.4%, 53.8%, and 45.7% respectively. And 3-year disease free survival rates were 43.2%, 23.7%, 23.6%, and 25.1% for the four groups. Stratification analysis showed that the gemcitabine regimen and conventional chemotherapy could significantly improve the survival rate and disease free survival rate for HCC patients who had major vascular invasion and/or microvascular invasion after liver transplantation compared with BSC group.

CONCLUSIONS

For HCC patients beyond Milan criteria, especially who had vascular invasion and/or micorvascular invasion, post-transplantation adjuvant chemotherapy can significantly improve survival. Gemcitabine is a proper regimen for postoperative adjuvant chemotherapy. Conventional chemotherapy can also benefit patients, but the adverse effects are not satisfactory.

摘要

背景

本研究旨在探讨肝移植术后超过米兰标准的肝细胞癌（HCC）患者接受辅助化疗对预防肿瘤复发和转移的影响。

方法

回顾性分析 2002 年 8 月至 2009 年 2 月期间因 HCC 超过米兰标准行原位肝移植（OLT）的 117 例患者。根据化疗方案将患者分为 4 组，比较不同化疗方案对生存、无病生存和不良反应的影响。

结果

吉西他滨组、常规化疗组、奥沙利铂联合卡培他滨组和最佳支持治疗（BSC）组的 1 年生存率分别为 87.5%、84.2%、81.6%和 67.5%。4 组的 3 年生存率分别为 48.1%、25.9%、31.6%和 33.7%。4 组的 1 年无病生存率分别为 69.8%、47.4%、53.8%和 45.7%。3 年无病生存率分别为 43.2%、23.7%、23.6%和 25.1%。分层分析显示，对于肝移植术后有大血管侵犯和/或微血管侵犯的 HCC 患者，吉西他滨方案和常规化疗与 BSC 组相比，能显著提高生存率和无病生存率。