Olthoff K M, Rosove M H, Shackleton C R, Imagawa D K, Farmer D G, Northcross P, Pakrasi A L, Martin P, Goldstein L I, Shaked A
Department of Surgery, UCLA School of Medicine, USA.
Ann Surg. 1995 Jun;221(6):734-41; discussion 731-43. doi: 10.1097/00000658-199506000-00012.
The aim of this study was to evaluate the effect of postoperative adjuvant chemotherapy on the recurrence rate and survival of patients after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC).
Historically, liver transplantation for HCC has yielded poor long-term survival. Multimodality therapy has been initiated in an effort to improve survival statistics.
Twenty-five patients were placed on 6 months of intravenous fluorouracil, doxorubicin, and cisplatin after OLT. Risk factors, recurrence rates, and survival rates were analyzed and compared with historic controls.
Overall long-term survival in the protocol patients was 46% at 3 years, improved over our historic controls of 5.8% at 3 years (p = 0.0001). Overall recurrence rate was 20% (n = 4). Possible risk factors, such as tumor size, vascular invasion, multifocality, capsular invasion, and tumor differentiation, were not found to be significantly predictive of survival. Three patients with long-term, disease-free survival had tumors > 5 cm. Side effects from chemotherapy were common, but rarely severe.
This study suggests that adjuvant chemotherapy after transplantation for HCC can provide long-term cure and may improve survival, even in patients with stage III and IV disease.
本研究旨在评估术后辅助化疗对肝细胞癌（HCC）原位肝移植（OLT）患者复发率和生存率的影响。
从历史上看，HCC肝移植的长期生存率较差。已启动多模式治疗以改善生存统计数据。
25例患者在OLT后接受6个月的静脉注射氟尿嘧啶、阿霉素和顺铂治疗。分析危险因素、复发率和生存率，并与历史对照进行比较。
方案组患者3年总长期生存率为46%，高于我们历史对照的3年生存率5.8%（p = 0.0001）。总复发率为20%（n = 4）。未发现肿瘤大小、血管侵犯、多灶性、包膜侵犯和肿瘤分化等可能的危险因素对生存有显著预测作用。3例长期无病生存的患者肿瘤>5 cm。化疗副作用常见，但很少严重。
本研究表明，HCC移植后辅助化疗可实现长期治愈，并可能提高生存率，即使是III期和IV期疾病患者。
