中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (31): 5879-5882.doi: 10.3969/j.issn.1673-8225.2011.31.043

• 肝移植 liver transplantation • 上一篇    下一篇

肝癌肝移植后亚砷酸化疗的应用

巫林伟，胡晓坤，何晓顺，邰  强，鞠卫强，王东平，马  毅，朱晓峰   

  1. 中山大学附属第一医院器官移植科，广东省广州市    510080
  • 收稿日期:2011-01-22 修回日期:2011-03-06 出版日期:2011-07-30 发布日期:2011-07-30
  • 通讯作者: 何晓顺，中山大学附属第一医院器官移植科，广东省广州市 510080
  • 作者简介:巫林伟☆，男，1978年生，福建省龙岩市人，汉族，2009年中山大学毕业，博士，主治医师，主要从事器官移植方面的研究。 并列第一作者：胡晓坤☆，女，1988年生，安徽省淮南市人，汉族，中山大学中山医学院在读博士。
  • 基金资助:

    广东省科技计划项目(200813030301308)“脑死亡供肝作为临床肝脏移植器官来源的实验及临床研究”。

Utilization of arsenious acid chemotherapy for hepatocellular carcinoma following liver transplantation

Wu Lin-wei, Hu Xiao-kun, He Xiao-shun, Tai Qiang, Ju Wei-qiang, Wang Dong-ping, Ma Yi, Zhu Xiao-feng   

  1. Organ Transplantation Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou  510080, Guangdong Province, China
  • Received:2011-01-22 Revised:2011-03-06 Online:2011-07-30 Published:2011-07-30
  • Contact: He Xiao-shun, Organ Transplantation Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China gdtrc@163.com
  • About author:Wu Lin-wei☆, Doctor, Attending physician, Organ Transplantation Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China lw97002@163.com Hu Xiao-kun☆, Studying for doctorate, Organ Transplantation Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China Wu Lin-wei and Hu Xiao-kun contributed equally to this paper.
  • Supported by:

    the Science and Technology Plan of Guangdong Province, No. 200813030301308*

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摘要：

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。

关键词: 亚砷酸, 肝移植, 肝癌, 化疗, 生存率

Abstract:

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.
METHODS: Twenty-three patients with HCC extending Milan criterion received intravenous arsenious acid chemotherapy after orthotopic liver transplantation (OLT), that is, intravenous injection, 10 mg per day, for 7 successive days, followed by 7-day interval, and a course comprised 4 durations. Each patient treated for 1-4 courses. Other 16 patients did not received chemotherapy served as controls. The difference of patients’ survival, tumor recurrence and adverse reaction were compared. 
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.

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