CAJ | 학술논문

背景:移植后肿瘤复发是影响肝癌肝移植疗效的主要因素,如何防止肝癌肝移植后肿瘤复发是目前肝移植研究的热点问题之一.亚砷酸全身化疗被认为对中晚期肝癌具有一定作用,但在肝移植后的应用还未见报道.目的:观察超出米兰标准的肝癌患者肝移植后应用亚砷酸全身化疗的对肿瘤复发的干预效果.方法:对23例超出米兰标准的肝癌患者肝移植后采用亚砷酸行预防性化疗:静脉滴注10 mg/d,连续使用7 d后间隔7 d,重复4次为1个疗程,患者接受1～4个疗程.观察以上使用亚砷酸化疗患者的生存、肿瘤复发情况,以及化疗不良反应,并与同期16例未使用化疗的肝癌肝移植患者相比较.结果与结论:经过3～32个月随访,共30例患者出现肝癌复发,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差异无显著性意义,但化疗组复发时间明显延迟(P=0.026)；两组6个月、1年生存率差异无显著性意义,化疗组2年生存率显著高于非化疗组(P=0.037)；两组6个月无瘤生存率差异无显著性意义,1年、2年无瘤生存率化疗组显著高于明显非化疗组(P=0.030,0.023).亚砷酸使用过程中未发现严重不良反应.提示肝癌肝移植患者静脉使用亚砷酸化疗可以延迟肿瘤复发,提高生存率.
배경:이식후종류복발시영향간암간이식료효적주요인소,여하방지간암간이식후종류복발시목전간이식연구적열점문제지일.아신산전신화료피인위대중만기간암구유일정작용,단재간이식후적응용환미견보도.목적:관찰초출미란표준적간암환자간이식후응용아신산전신화료적대종류복발적간예효과.방법:대23례초출미란표준적간암환자간이식후채용아신산행예방성화료:정맥적주10 mg/d,련속사용7 d후간격7 d,중복4차위1개료정,환자접수1～4개료정.관찰이상사용아신산화료환자적생존、종류복발정황,이급화료불량반응,병여동기16례미사용화료적간암간이식환자상비교.결과여결론:경과3～32개월수방,공30례환자출현간암복발,화료조16례,비화료조14례,복발부위최상견우폐부、이식간급골격.화료조여비화료조종류복발솔차이무현저성의의,단화료조복발시간명현연지(P=0.026)；량조6개월、1년생존솔차이무현저성의의,화료조2년생존솔현저고우비화료조(P=0.037)；량조6개월무류생존솔차이무현저성의의,1년、2년무류생존솔화료조현저고우명현비화료조(P=0.030,0.023).아신산사용과정중미발현엄중불량반응.제시간암간이식환자정맥사용아신산화료가이연지종류복발,제고생존솔.
BACKGROUND: Tumor recurrence in liver transplant recipients greatly affects prognosis of liver transplantation with hepatocellular carcinoma (HCC). How to prevent tumor recurrence has aroused increasing attention. Arsenious acid chemotherapy is considered effective on treating moderate or advanced liver cancer, but its utilization following liver transplantation remains few. OBJECTIVE: To explore the role of arsenious acid on tumor recurrence in liver transplant patients with primary HCC extending Milan criteria. RESULTS AND CONCLUSION: All patients were routinely followed up for 3-32 months. Thirty recipients were presented with tumor recurrence, 16 in the chemotherapy group and 14 in the non-chemotherapy group. Tumor recurred in lung, liver graft and bones in most cases. The total recurrence rate was similar in these two groups, but chemotherapy could delay recurrence after transplantation (P=0.026). There was no significance in 6-month, 1-year survival rate between two groups, but the 2-year survival in the chemotherapy group was higher (P=0.037); 6-month tumor-free survival rates in the two groups had no significance, 1-year and 2-year tumor-free in the chemotherapy group were significantly higher than those in the non-chemotherapy group (P=0.030, 0.023). Intravenous arsenious acid chemotherapy can delay tumor recurrence and prolong survival in liver transplant patients with HCC extending Milan criteria.