mTOR抑制剂对肝细胞癌肝移植患者术后生存的影响

目的研究肝细胞癌患者肝移植术后使用mTOR抑制剂为主的免疫抑制剂方案对肿瘤复发及生存期的影响。方法收集我中心2005年1月至2008年12月期间因肝细胞癌行肝移植手术的病例建立数据库。根据患者术后所使用的免疫抑制方案分为两组,单CNIs免疫抑制剂组和含西罗莫司(Rapa)组。按照术前肿瘤所符合的移植标准(米兰标准、UCSF标准以及超标准)对组内病例分层分析,对比各组病例之间在肿瘤复率发、无瘤生存期及总生存期方面的差别。结果对于米兰标准及UCSF标准患者,两组间在肿瘤复发率、无瘤生存期和总生存期方面差别无统计学意义;超标准患者两组无瘤生存率无显著差异,含Rapa组总生存期优于单CNIs组(P0.05)。结论超标准肝癌患者术后使用mTOR抑制剂对于延长患者生存期具有一定作用。

Impact of mTOR inhibitors on the survival of Hepatocellular Carcinoma After Liver Transplantation

Objective To analyze the effect of mTOR inhibitor-based immunosuppression on the survival of hepatocellular car- cinoma after liver transplantation（LT）. Methods The clinical data of hepatocellular carcinoma patients who underwent LT from Jan, 2005 to Dec ,2008 were reviewed retrospectively. Patients were divided into two groups： group CNIs, calcineurin inhibitors without sirolimus; group Rapa, sirolimus with calcineurin inhibitors or sirolimus alone. Results For patients within Milan criteria or UCSF criteria, the difference between the two groups in the rate of tumor recurrence, tumor-free survival and overall survival rate were not sta- tistically significant. For patients beyond the UCSF criteria, the overall survival rate in group Rapa was better than that in group CNIs （P 〈 0. 05）. Conclusions To patients beyond UCSF criteria, roTOR inhibitor-based immunosuppression regimen is recommended to prolong survival rate of patients with a certain role.