Stone M J, Klintmalm G B, Polter D, Husberg B S, Mennel R G, Ramsay M A, Flemens E R, Goldstein R M
Department of Oncology, Sammons Cancer Center, Dallas, Texas.
Gastroenterology. 1993 Jan;104(1):196-202. doi: 10.1016/0016-5085(93)90852-4.
Liver transplantation for unresectable hepatocellular carcinoma yields disappointing results. Most cases recur within 2 years, often in the transplanted liver.
A combination of neoadjuvant doxorubicin and orthotopic liver transplantation was used in 20 patients with unresectable hepatocellular carcinoma confined to the liver. Seventeen patients had tumors > 5 cm in greatest diameter, and 11 cases were stage IVA by the TNM classification. Doxorubicin was administered preoperatively, intraoperatively, and postoperatively at a dose of 10 mg/m2 weekly, totaling 200 mg/m2.
Chemotherapy was well tolerated although leukopenia was observed in 70% of patients. Eight patients died, five of recurrent tumor and three of hepatitis B. Three others remain alive 8-22 months after tumor recurrence. One patient had initial tumor recurrence in the allograft. Actuarial survival is 59% and tumor-free survival is 54% at 3 years. For the 17 patients with tumors > 5 cm, overall survival is 63% and tumor-free survival is 49% at 3 years.
The results of this pilot study suggest that neoadjuvant doxorubicin chemotherapy favorably alters the post-transplant survival of patients with hepatocellular carcinoma.
不可切除肝细胞癌的肝移植效果令人失望。大多数病例在2年内复发，且常发生于移植肝内。
对20例局限于肝脏的不可切除肝细胞癌患者采用新辅助阿霉素与原位肝移植相结合的方法。17例患者肿瘤最大直径>5 cm，11例根据TNM分类为IVA期。阿霉素在术前、术中和术后给药，剂量为每周10 mg/m²，总量为200 mg/m²。
化疗耐受性良好，尽管70%的患者出现白细胞减少。8例患者死亡，5例死于肿瘤复发，3例死于乙型肝炎。另外3例在肿瘤复发后8 - 22个月仍存活。1例患者在移植肝中出现初始肿瘤复发。3年时的精算生存率为59%，无瘤生存率为54%。对于17例肿瘤>5 cm的患者，3年时的总生存率为63%，无瘤生存率为49%。
这项初步研究结果表明，新辅助阿霉素化疗可改善肝细胞癌患者移植后的生存情况。
