超出Milan标准肝癌肝移植患者术后预防性化疗的价值  

Preventive chemotherapy for hepatocellular carcinoma exceeding Milan criteria after liver transplantation

作　　者：王征[1] 樊嘉[1] 周俭[1] 吴志全[1] 邱双健[1] 黄晓武[1] 余耀[1] 孙健[1] 

机构地区：[1]复旦大学附属中山医院肝外科、复旦大学肝癌研究所,上海200032

出　　处：《中华消化外科杂志》2008年第4期268-270,共3页Chinese Journal of Digestive Surgery

基　　金：国家863项目资助（AA022479）;上海市科委重点项目基金资助（054119530）

摘　　要：目的探讨超出Milan标准肝癌肝移植患者术后预防性化疗的价值。方法回顾性分析2001年4月至2007年7月243例超出Milan标准肝癌肝移植患者的临床资料，其中预防性化疗162例，未化疗81例。结果预防性化疗与未化疗患者术后1、3年生存率（78．5％、63．7％和56．6％、39．1％）以及无瘤生存率（76．8％、52．5％和69．3％、64．7％）比较差异无统计学意义（X^2=3．084，0．444，P〉0．05）。Cox风险比例分析显示，对无大血管侵犯的肝癌肝移植患者，术后是否化疗不是影响生存率的独立因素；对有大血管侵犯的肝癌肝移植患者，术后是否化疔是影响生存率的独立因素。结论对于超出Milan标准且伴有大血管侵犯的肝癌肝移植患者，术后早期预防性化疗可以延缓肿瘤复发，明显提高疗效。Objective To investigate the effects of preventive chemotherapy for hepatocellular carcinoma （HCC） exceeding Milan criteria after liver transplantation. Methods The clinical data of 243 patients who had undergone orthotopic liver transplantation for HCC exceeding Milan criteria from April 2001 to July 2007 were retrospectively analyzed. Of all patients, 162 received preventive chemotherapy after transplantation. Results The 1- and 3-year survival rates and disease-free survival rates were not statistically different between patients who had received chemotherapy （78.5% , 63.7% ; 76.8% , 52.5% ） and those without chemotherapy （56.6% , 39.1%; 69.3% , 64.7% ） （X^2 =3.084, 0.444, P 〉0.05）. Cox regression analysis demonstrated that postoperative chemotherapy was not an independent factor affecting the survival rates of HCC patients without vascular invasion, but an independent factor affecting the survival rates of HCC patients with vascular invasion. Conclusions Early preventive chemotherapy could obviously increase the survival rate and delay the tumor recurrence of patients with HCC exceeding Milan criteria, especially for HCC patients with vascular invasion.

关 键 词：肝肿瘤 肝移植 预防性化疗 

分 类 号：R735.7[医药卫生—肿瘤] R657.3[医药卫生—临床医学]