进展期肝癌肝移植围手术期辅助性化疗的临床价值  

Clinical study of perioperative adjuvant chemotherapy for advanced hepatocellular carcinoma

作　　者：孙建[1] 简志祥[1] 侯宝华[1] 区应亮[1] 区金锐[1] 

机构地区：[1]广东省人民医院肝胆外科,广州市510080

出　　处：《实用医学杂志》2006年第14期1601-1603,共3页The Journal of Practical Medicine

基　　金：广东省科技计划资助项目(编号:2002B30207-3)

摘　　要：目的:探讨围手术期辅助性化疗对预防进展期肝癌(pTNM分期:Ⅲ、Ⅳa)肝移植术后肝癌复发、提高患者生存率的临床价值,并评价其可行性、安全性。方法:回顾分析2002年4月至2004年10月于我院接受肝移植的25例Ⅲ、Ⅳa期肝癌患者的临床资料,其中12例肝癌患者(化疗组)术前均接受经皮肝动脉栓塞化疗(TACE),术中、术后均采用阿霉素(ADM)+5-氟尿嘧啶(5-Fu)+顺铂(CDDP)方案行全身静脉化疗,以未接受任何辅助化疗的13例患者为对照组(未化疗组),比较两组的肿瘤复发率、累计生存率和无瘤生存率;观察该化疗方案的安全性及副作用。结果:经统计分析,化疗组肿瘤复发率(7/12,58.3%)明显低于未化疗组(11/13,84.6%)(P<0.05)。化疗组和未化疗组1、2年生存率分别为75.0%、58.3%和53.8%、30.7%,两组术后累计生存率比较差异有显著意义(P<0.05);化疗组1、2年无瘤生存率(66.7%、41.6%)亦高于未化疗组(38.5%、15.4%),两者比较差异有显著意义(P<0.05)。化疗组全部患者未出现与化疗相关的肝肾毒性,副反应轻。结论:围手术期辅助性化疗可显著提高进展期肝癌肝移植术后生存率,预防肝癌术后复发。肝移植围手术期使用ADM+5-Fu+CDDP化疗方案安全可行,具有临床应用价值。Objective To evaluate the feasibility, reliability and clinical value of perioperative adjuvant chemotherapy in the prevention of tumor recurrence and improvement of the survival rate after liver transplantation for advanced hepatocellular carcinoma. Methods 12 cases of advanced hepatocellular carcinoma （HCC） （pTNM stage： Ⅲ and Ⅳa） who had received liver transplantation and perioperative adjuvant chemotherapy （preoperative TACE in combination with intraoperative and postoperative ADM ＋5-Fu ＋CDDP） were retrospectively reviewed and compared with 13 eases who had received liver transplantation alone. The rate of tumor recurrence and the cumulative and tumor-free survival rates in two groups were compared and the feasibility and side effects of this perioperative chemotherapy were also studied. Results The rate of tumor recurrence in the chemotherapy group was significantly lower than that in the non-chemotherapy group （7/12, 58.3% vs 11/13, 84. 6% ） （ P 〈 0. 05）. The 1- and 2-year overall survival rates were 75.0% and 58.3% in the chemotherapy group and 53.8% and 30.7% in the non-chemotherapy group. There was a significant difference of cumulative survival rate between two groups（P 〈 0.05） . The 1- and 2-year tumor-free survival rates in the chemotherapy group （66.7% and 41.6% ） were markedly higher than those in the non-chemotherapy group（38.5% and 15.4% ） （ P 〈 0. 05）. No chemotherapy-induced hepatotoxicity and nephrotoxicity was found in the chemotherapy group. Conclusions The pefioperative adjuvant chemotherapy can significantly decrease tumor recurrence and prolong the life-span of patients with advanced HCC after liver transplantation. The chemotherapy with ADM ＋ 5-Fu ＋ CDDP is feasible and has mild aide effects.

关 键 词：肝肿瘤 肝移植 辅助化疗 预后 

分 类 号：R735.7[医药卫生—肿瘤]