进展期肝癌肝移植术后采用奥沙利铂联合氟尿嘧啶-甲酰四氢叶酸钙辅助化疗的安全性

目的探讨进展期肝癌肝移植术后采用＂奥沙利铂（Oxaliplatin,OXA/L-OHP）＋氟尿嘧啶（5-Fu）＋甲酰四氢叶酸钙（CF）＂辅助化疗的临床安全性分析。方法分析我院施行了原位肝移植手术的58例进展期原发性肝癌（HCC）伴肝硬化患者,其中治疗组为26例不符合米兰标准的肝癌患者,术后进行辅助化疗;其余32例行单纯手术治疗。采用＂OXA/L-OHP＋5-Fu＋CF＂化疗方案,每次化疗间隔21 d,共6个周期。治疗期间及治疗后记录患者的不良反应和生存情况。结果化疗患者术后3年的生存率为78.8%;未化疗患者术后3年的生存率为53.6%。化疗不良反应以骨髓抑制为主。27例出现骨髓抑制的患者中,24例出现白细胞减少,其中12例接受重组人粒细胞集落刺激因子治疗;7例出现血小板减少,其中仅4例接受重组人血小板生成素治疗。无1例出现排异反应以及发生与治疗相关的死亡及感染。无1例患者因化疗毒副反应中断化疗。结论进展期肝癌肝移植术后采用＂OXA/L-OHP＋5-Fu＋CF＂辅助化疗是安全,可行的。

Safety study of adjuvant chemotherapy with oxaliplatin and 5 -Fu and CF after liver transplantation for hepatocellular carcinoma

Objective To evaluate the safety of postoperative adjuvant chemotherapy on the recurrence rate and survival of patients for hepatoeellular carcinoma （HCC） after liver transplantation （ LT）. Methods Fifty - eight consecutive HCC patients with liver cirrhosis who did not conform Milancriteria underwent LT. Twenty - six invasive HCC patients were entered into a prospec- tive prophylactic protocol with three week cycles of oxaliplatin plus 5 -fluorouracil（5 -Fu ）and calcium formyltetrahydrofolat （CF） for a maximum of six cycles. The adverse reactions and survival were recorded during treatment and after completion of treatment. Results The 3 - year survival in the non - Milan HCC patients with post - LT chemotherapy was 86.2% , and that in the non - Mi- lan HCC patients without post - LT chemotherapy was 53.6%. Myelosuppression was noted in 27 patients, 24 patients had leukope- nia and 12 of these needed treatment with granulocyte - colony stimulating factor （ G - CSF）. Seven patients had thromboeytopenia, only four of whom were treated with recombinant human thrombopoietin. There were no events corresponding to transplant rejection in any of the patients given adjuvant chemotherapy. There were no deaths or severe infections attributable to chemotherapy. The chemo- therapy regimen was well tolerated and no one broke off chemotherapy owing to clinical side effects. Conclusions Post - LT adju- vant chemotherapy with oxaliplatin and 5 - Fu - CF is safe and feasible in treatment of advanced HCC patients who do not meet the Milan criteria after LT.