CAJ | 학술논문

目的探讨西罗莫司与他克莫司对超米兰标准原发性肝癌患者肝移植后肿瘤复发的影响.方法采用区组随机法将2008年1月至2012年4月间接受肝移植治疗的超米兰标准的原发性肝癌患者61例分为西罗莫司组(30例)和他克莫司组(31例).他克莫司组采用以他克莫司为基础的免疫抑制方案,皮质激素仅用1个月,视情况使用吗替麦考酚酯,但用量不超过1.5 g/d.西罗莫司组术后1个月内的免疫抑制方案同他克莫司组,术后1个月开始将他克莫司分步转换为西罗莫司.肿瘤复发或转移前不采取抗肿瘤措施.有复发或转移之后,依具体情况进行肿瘤局部治疗和(或)全身药物治疗.比较两组受者肿瘤复发率和受者存活率.结果术后随访时间为10.3～60.2个月,中位数为35.2个月.西罗莫司组术后1、2、3和4年肿瘤复发率分别为13.3％、36.7％、43.3％和53.3％,均显著低于他克莫司组(38.7％、67.7％、74.2％和77.4％),差异均有统计学意义(P＜0.05).西罗莫司组的受者1年存活率为90.0％,他克莫司组为87.1％ (P＞0.05),但西罗莫司组的2、3和4年受者存活率(53.3％、33.3％和20.0％)均显著高于他克莫司组(41.9％、22.6％和9.7％),差异均有统计学意义(P＜0.05).两组间肝、肾功能异常发生率的差异无统计学意义(P＞0.05).结论与他克莫司相比,西罗莫司能显著降低超米兰标准原发性肝癌患者肝移植后的肿瘤复发率,提高受者的存活率.
목적 탐토서라막사여타극막사대초미란표준원발성간암환자간이식후종류복발적영향.방법 채용구조수궤법장2008년1월지2012년4월간접수간이식치료적초미란표준적원발성간암환자61례분위서라막사조(30례)화타극막사조(31례).타극막사조채용이타극막사위기출적면역억제방안,피질격소부용1개월,시정황사용마체맥고분지,단용량불초과1.5 g/d.서라막사조술후1개월내적면역억제방안동타극막사조,술후1개월개시장타극막사분보전환위서라막사.종류복발혹전이전불채취항종류조시.유복발혹전이지후,의구체정황진행종류국부치료화(혹)전신약물치료.비교량조수자종류복발솔화수자존활솔.결과 술후수방시간위10.3～60.2개월,중위수위35.2개월.서라막사조술후1、2、3화4년종류복발솔분별위13.3％、36.7％、43.3％화53.3％,균현저저우타극막사조(38.7％、67.7％、74.2％화77.4％),차이균유통계학의의(P＜0.05).서라막사조적수자1년존활솔위90.0％,타극막사조위87.1％ (P＞0.05),단서라막사조적2、3화4년수자존활솔(53.3％、33.3％화20.0％)균현저고우타극막사조(41.9％、22.6％화9.7％),차이균유통계학의의(P＜0.05).량조간간、신공능이상발생솔적차이무통계학의의(P＞0.05).결론 여타극막사상비,서라막사능현저강저초미란표준원발성간암환자간이식후적종류복발솔,제고수자적존활솔.
Objective To compare the impact of the sirolimus and tacrolimus on the tumor recurrence after liver transplantation due to HCC beyond Milan criteria.Method Sixty-one liver transplantation recipients due to HCC beyond Milan criteria,between Jan.2008 and Apri.2012,were randomized,with the informed consent,into two different immunosuppression groups: sirolimus group (n=30) and tacrolimus group (n=31).In tacrolimus group,tacrolimus was used as the basic immunosuppressant,methylprednisolone was discontinued within one month postoperatively,and mycophenolate mofetil was used within the dosage of 1.5 g/d accordingly.In sirolimus group,the immunosuppresive scheme was the same as that of the tacrolimus group within postoperative one month,and from that,tacrolimus was transferred to sirolimus.No antineoplastic agents were given before tumor recurrence.The tumor recurrence rate and the survival rate of the recipients were compared between the two groups.Result The median follow-up duration was 35.2 months (10.3～ 60.2).The tumor recurrence rate at postoperative year 1,2,3 and 4 in the sirolimus group (13.3％,36.7％,43.3％ and 53.3％) was significantly lower than that in the tacrolimus group (38.7％,67.7％,74.2％ and 77.4％),P ＜ 0.05 for all.The one-year survival rate in the recipients postoperation had no significant difference between sirolimus group and tacrolimus group (90.0％ vs.87.1％,P=0.438).The 2-,3-and 4-year survival rate in the recipients was significantly higher in the sirolimus group (53.3％,33.3％ and 20.0％) than that in the tacrolimus group (41.9％,22.6％ and 9.7％),P ＜ 0.05 for all.The liver function and renal function of the recipients at the postoperative year 1,2,3 and 4 showed no significant difference between the two groups,P＞0.05.Conclusion In comparison with tacrolimus,sirolimus could significantly reduce the tumor recurrence rate and increase the survival rate for the liver transplant recipients due to HCC beyond Milan criteria.