超出米兰标准的原发性肝癌肝移植术后化疗对患者存活和肿瘤复发率的影响

目的 探讨超出米兰标准的原发性肝癌肝移植术后化疗对患者存活时间及肿瘤复发率的影响。方法 2002年7月至2004年12月间对46例超出米兰标准的原发性肝癌患者行原位肝移植，其中44例患者接受术后化疗，分析术后化疗患者的临床资料，观察化疗后的不良反应，统计患者肝移植术后的存活率及肿瘤复发率，比较术前是否存在癌栓以及术后是否化疗对存活率和肿瘤复发率的影响。结果 44例患者在化疗过程中均出现不同程度的胃肠道反应；16例患者出现肝功能损害，经停药、调整免疫抑制剂用量及使用护肝药后恢复；7例患者出现白细胞减少，采用粒细胞集落刺激因子类药物治疗后恢复正常。肝移植术后化疗的患者存活超过1年的有22例，1年存活率为47．8％，最长存活至今已有30个月。26例患者在1年内肿瘤复发，1年复发率为59．1％。术前有癌栓的患者术后肿瘤复发率明显高于无癌栓的患者，存活率明显低于无癌栓的患者。肝移植术后化疗的患者与术后未化疗的患者相比，存活率升高，肿瘤复发率降低。结论 超出米兰标准的原发性肝癌患者肝移植术后化疗可提高生存率，减少肿瘤复发的可能。肝移植术后辅助性化疗是安全、可行的，且患者可以耐受。

Postoperative chemotherapy of liver transplantation for primary hepatic carcinoma exceeding Milan criteria

Objective To investigate the effect of postoperative chemotherapy of liver transplantation for primary liver carcinoma exceeding Milan criteria. Methods Forty-six cases of primary liver carcinoma exceeding Milan criteria underwent orthotopic liver transplantation in our hospital from July 2002 to Dec. 2004. Among them, 44 received general chemotherapy post-operatively. The clinical data, the side reactions, survival rate and recurrent rate of tumor after chemotherapy were analyzed. The effect of cancer embolus pre-operation and post-operative chemotherapy on the survival rate and recurrent rate of tumor was investigated. Results All patients had gastrointestinal adverse reactions to varying degrees during chemotherapy. Abnormal liver function in 16 patients recovered after withdrawal of drugs, adjusting the dosage of immunosuppressants and using liver aid. In 7 patients having aleucocytosis, the lencocyte count recovered normally after using G-CSF. One patients died perioperatively and the longest survive time was 30 months. Twenty-two cases subject to chemotherapy after liver transplantation survived longer than 12 months. The postoperative one-year survival rate was 47. 8 %. Twenty-six had tumor recurrence in one year with the one-year recurrent rate being 59.1%, significantly lower than those without preoperative cancer embolus. The survival rate was higher and recurrent rate of tumor was lower in the patients subject to chemotherapy after transplantation than in those not subject to chemotherapy. Conclusions Post-transplant chemotherapy to the patients with primary liver carcinoma exceeding Milan criteria could increase the survival rate, reduce the possibility of tumor recurrence. The chemotherapy of the HCC patients after liver transplantation is safe, feasible and acceptable.