索拉非尼预防超米兰标准肝癌患者肝移植术后复发

目的 观察超米兰标准的肝癌患者在肝移植术后应用索拉非尼预防肿瘤复发的效果.方法 将2008年3月至2010年6月30例行肝移植手术的超米兰标准肝癌患者分为两组,每组各15例.实验组:口服索拉非尼400 mg,bid.对照组:口服卡培他滨1500 mg,bid,每个疗程服用14d后休息2周.术后18个月两组未复发者均停止用药,治疗过程中出现复发者则维持原剂量直至患者不宜再继续服药.出现严重不良反应者减量或停药.结果 实验组1年复发率为53.3％,对照组86.6％,2组比较差异有统计学意义(x2=3.968,P＜0.05).实验组1年生存率为93.3％,对照组46.6％,组间比较差异有统计学意义(x2=7.777,P＜0.05).实验组的生存期为7～28个月,平均(24.6±1.7)个月,对照组的生存期为5～34个月,平均(16.4±2.7)个月,实验组患者的生存时间长于对照组,差异有统计学意义(x2=7.154,P＜0.05).实验组及对照组的毒副反应大部分为Ⅰ～Ⅱ级,其中实验组发生腹泻、手足综合征的机会较对照组高.结论 超米兰标准的肝癌患者在肝移植术后预防应用索拉非尼可能会减少或推迟肝癌复发,延长患者的生存期,药物的大部分不良反应患者可以耐受.

Postoperative use of Sorafenib in liver transplantation patients of hepatocellular carcinoma beyond Milan criteria

Objective To observe the efficacy of Sorafenib in preventing and treating tumor recurrence after liver transplantation for patients with primary hepatic carcinoma beyond Milan criteria.Methods From March 2008 to June 2010,30 patients of liver transplantation with primary hepatic carcinoma exceeding Milan criteria were randomized into 2 groups,each group of 15 cases.Beginning one month posttransplantatoin patients in the experimental group received oral administration of Sorafenib (400 mg bid),while those in the control group received Capecitabine ( 1500 mg bid) for 14 days every 4 weeks.Drug was withdrawn in patients without recurrence in 18 months after transplantation,recurrent patients maintained the original dose until they were not suitable for the medication.Results The 1 year recurrence rate in experimental group was 53.3％,that in control group was 86.6％ ( x2 =3.968,P ＜ 0.05).The 1 year survival rate in experimental group was 93.3％,that in the control group was 46.6％( x2 =7.777,P ＜ 0.05 ).The mean survival time of patients in experimental group was (24.6 ± 1.7 ) months (7 - 28 months),that in the control group was ( 16.4 ± 2.7 ) months ( 5 - 34 months ) ( x2 =7.154,P ＜ 0.05).Most adverse reactions in both groups were of grade Ⅰ - Ⅱ.The incidence of diarrhea and handfoot syndrome in experimental group is higher than that in control group.Conclusions Using Sorafenib for patients with primary hepatic carcinoma exceeding Milan criteria after liver transplantation may reduce carcinoma recurrence rate,and prolong patients' survival time.