索拉非尼治疗肝癌肝移植术后肿瘤复发的临床疗效观察

目的探讨索拉非尼治疗原发性肝癌（肝癌）肝移植术后肿瘤复发晚期患者的治疗效果及不良反应。方法回顾性分析2010年3月至2012年5月郑州人民医院肝脏外科中心收治的9例肝癌肝移植术后肿瘤复发晚期患者的临床资料。确诊肝癌复发后仍然继续原免疫抑制方案，抗肿瘤治疗予索拉非尼口服每次400mg，每日2次，直至病情进展、发生严重不良反应或死亡中止用药。9例患者每月至少随访1次，全面评价病情，同时检测血清甲胎蛋白（AFP）水平、排斥反应及药物不良反应等情况。结果9例患者中部分缓解2例，疾病稳定4例，疾病进展3例。用药后2例患者AFP进行性上升，4例患者AFP水平稳定（升高≤10％），3例AFP水平明显下降（下降≥50％）。中位肿瘤进展时间为4．2个月，总生存期为6．9个月。不良反应的严重程度主要为1或2级，包括皮疹、腹泻、手足皮肤反应、恶心、呕吐、脱发、食欲减退、乏力、高血压等。经对症处理后患者均能耐受，无1例因药物不良反应而终止治疗。9例患者服用索拉非尼后均未发生排斥反应。结论索拉非尼作为一种新型多靶向性抗肿瘤药物，对肝癌肝移植术后肿瘤复发的晚期患者有一定的疗效。

Clinical curative effect of sorafenib on the treatment of recurrent primary liver cancer after liver transplantation

Objective To investigate the curative effect and adverse reaction of sorafenib on the treatment of late stage of recurrent primary liver cancer after liver transplantation. Methods Clinical data of 9 patients with late stage of recurrent primary liver cancer after liver transplantation from March 2010 to May 2012 in Liver Surgery Center of Zhengzhou People＇s Hospital were analyzed retrospectively. After the diagnosis of tumor recurrence, the original immunosuppressive scheme continued and the antineoplastic therapy with sorafenib orally （400 mg every time, twice every day） was given until disease progressed, or severe adverse reaction and death happened. Nine patients were followed up at least once a month. The tumor recurrence was evaluated and the level of serum alpha-fetoprotein （AFP） , rejection and adverse reaction were detected at the same time. Results In 9 patients, 2 cases got partial remission, 4 cases got disease stablization and 3 cases got disease progress. The AFP level increased in 2 cases, kept stable in 4 cases （ increased less than 10% ） and significantly decreased in 3 cases （decreased more than 50% ） . The median time of tumor progress was 4. 2 months and the total survival time was 6. 9 months. The severity of adverse reaction was 1 or 2 grade, including rash, diarrhea, hand-foot skin reaction, nausea, vomit, alopeeia, anorexia, weak, hypertension and so on. After symptomatic treatment, all of the patients were able to tolerate the adverse reaction and no one stopped the treatment for adverse reaction. No rejection occurred during sorafenib treatment in 9 patients. Conchlsions As a new type of antineoplastic medicine with many targets, sorafenib has certain effect on the late stage of recurrent primary liver cancer after liver transplantation.