肝癌肝移植术后应用亚砷酸化疗的临床效果观察

目的 探讨超出米兰标准的肝癌病人肝移植术后应用亚砷酸全身化疗对肿瘤复发的意义.方法 对23例超出米兰标准的肝癌病人肝移植术后采用亚砷酸化疗:静脉滴注10 mg/d,连续使用7 d后间隔7 d,重复4次为1疗程.以上病人接受1～4个疗程治疗.观察化疗病人的生存情况、肿瘤复发情况以及化疗副作用,并与同期16例未使用化疗的肝癌肝移植病人相比较.结果 经过3～32个月随访,共有30例病人出现肝癌复发,化疗组16例,非化疗组14例,复发部位最常见于肺部、移植肝及骨骼.化疗组与非化疗组肿瘤复发率无明显差异,出现肝癌复发的时间分别为移植术后(14.5±7.5)个月和(10.2±4.6)个月,化疗组复发时间明显延迟(P=0.026);6个月、1年生存率分别为91.3%、87.0%和93.7%、87.5%,两组间无明显差异,化疗组2年生存率明显高于非化疗组(73.9% vs 50.0%,P=0.037);6个月无瘤生存率无明显差别(87.0% vs 81.2%)、1、2年无瘤生存率化疗组明显高于非化疗组(82.6% vs 50.0%,P=0.030;65.2% vs 43.7%,P=0.023).亚砷酸使用过程中未发现严重副作用.结论 静脉使用亚砷酸化疗在超出米兰标准的肝癌肝移植病人中可以延迟肿瘤复发,改善病人长期存活情况.

Influence of arsenious acid chemotherapy on tumor recurrence in liver transplant recipients with primary hepatocellular carcinoma

Objective To explore the role of arsenious acid on tumor recurrence in liver transplant recipients with primary hepatocellular carcinoma (HCC) extending Milan criteria.Methods Twenty-three patients with HCC extending Milan criterion received intravenous arsenious acid chemotherapy after orthotopic liver transplantation (OLT),while the other 16 patients with similar pretransplant situations did not received chemotherapy after the operation.The difference of patients survival and tumor recurrence were compared.Results All the 39 patients were routinely followed up for 3-32 months.Thirty recipients were found to have tumor recurrence and 16 in chemotherapy group and 14 in non-chemotherapy group.The tumor recurred in lung,liver graft and bones in most of the cases.The total recurrence rate was similar in these two groups,but chemotherapy could delay recurrence after transplantation(14.5±7.5 m vs 10.2±4.6 m,P=0.026).Six-month and 1-year survival rate were similar (91.3% vs 93.7 and 87.0% vs 87.5,respectively),while 2-year survival in chemotherapy group was higher (73.9% vs 50.0%,P=0.037),6-mon tumor-free survival rates in the two groups were similar (87.0% vs 81.2%),1-year and 2-year tumor-free in chemotherapy group were significantly higher than those in non-chemotherapy group (82.6% vs 50.0%,P=0.030 and 65.2% vs 43.7 %,P=0.023).Conclusion Intravenous arsenious acid chemotherapy can delay the tumor recurrence and prolong the survival in liver transplant patients with HCC extending Milan criteria.