肝癌肝移植术后索拉非尼治疗肿瘤复发与胰腺萎缩的关系  

The relationship between tumor recurrence treated with sorafenib in patients with hepatocellular carcinoma after liver transplantation and pancreatic atrophy

作　　者：庄莉[1] 钟海钢 屠振华[1] 王卓轶[1] 章茫里[1] 张珉[1] 郑树森[1] 

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科,杭州310003

出　　处：《中华移植杂志（电子版）》2016年第2期60-65,共6页Chinese Journal of Transplantation(Electronic Edition)

基　　金：浙江省医药卫生科技项目一般项目(2016KYA073)

摘　　要：目的探索肝癌肝移植术后肿瘤复发的患者,长期服用索拉非尼与胰腺体积动态变化及相关不良反应的关系。方法回顾性分析浙江大学医学院附属第一医院因肝癌行肝移植,且术后发生肝细胞肝癌（HCC）复发转移,并于2013年1月至12月期间开始服用索拉非尼治疗并存活2年以上患者的临床和影像资料。观察索拉非尼不良反应的发生情况,索拉非尼治疗前、后均行腹部增强CT,并对胰腺进行半自动逐层冠状位和矢状位的三维重建。服药前后胰腺体积中位数的比较及发生和未发生手足皮肤反应（HFSR）的患者胰腺萎缩程度的比较采用Wilcoxon符号秩和检验。结果研究共纳入9例肝移植术后HCC复发接受索拉非尼治疗的患者,男性7例,女性2例;开始服用索拉非尼的中位年龄为44岁（35~65岁）。截至2016年3月,中位随访时间35.8个月（26.5~52.8个月）,患者移植肝功能稳定,随访过程中未发生排斥反应,均带瘤生存,按世界卫生组织实体肿瘤改良疗效评价标准评估为疾病稳定。9例患者服药前、后接受了共计32次胰腺体积CT检查,均出现了胰腺体积减少,首次发现胰腺萎缩的中位时间为服药后3个月（2~36个月）。患者服药前和服药后最后一次CT检查胰腺体积中位数分别为70.4 m L和59.2 m L,减少了16%,差异有统计学意义（Z=-2.55,P〈0.05）。3例发生HFSR的患者和6例未发生HFSR的患者最后一次CT检查胰腺萎缩程度分别为24%和11%,差异有统计学意义（Z=-1.81,P〈0.05）,结论肝癌肝移植术后接受索拉非尼治疗肿瘤复发的患者可出现胰腺萎缩,胰腺萎缩与索拉非尼的服药时间有一定关系,服药早期（服药后3个月内）即可出现体积减少,这种体积变化可长期存在且多数不可逆。Objective To investigate the changing pattern of pancreatic volume and other adverse effects among a cohort of liver transplantation（ LT） recipients with hepatocellular carcinoma（ HCC） recurrence who were treated with sorafenib. Methods We retrospectively analyzed the clinical and radiological data of HCC recurrent patients after LT in the First Affiliated Hospital,Zhejiang University School of Medicine from January 2013 to December 2013 began with treatment of sorafenib and survived for more than 2 years. Sorafenib side effects were collected at every month interval and abdominal enhanced CT scan were performed before and under sorafenib treatment at multiple time points. Pancreas volumes were calculated through semi-manually segmented section by section in both coronal and sagittal reconstruction. Results Nine cases（ 7 males and 2 females） met inclusion criteria were enrolled. The median age was 46 years old（ 35-65 years old） when beginning sorafenib treatment. Up to March 2016,the median follow-up time was 35. 8 months（ 26. 5-50. 8 months）. The graft function was stable in all cases and no early or late rejection occurred during follow-up. All caseswere survival with tumor and in the stable disease by mRECIST. Nine patients received 32 CT scans before and after sorafenib treatment and all of them had a pancreatic volume loss. The median time to detect the volume loss was 3 months（ 2-36 months） and the volume reduction can reach 29%. The median pancreatic volume before the onset of sorafenib was 70. 4 m L while 59. 2 m L at the last CT scan under sorafenib,resulting a significant volume reduction by 16%（ Z =- 2. 55,P 〈 0. 05）. The volume loss at the last CT scan in HFSR cases（ 24%,n = 3） was significantly higher than no-HFSR cases（ 11%,n = 6）（ Z =- 1. 81,P 〈 0. 05）. Conclusion The results confirmed pancreatic atrophy after sorafenib therapy in part of HCC recurrence patients post LT,while the variation pattern of pancreatic volume could correlate with sorafenib exposu

关 键 词：肝移植 肝细胞肝癌 索拉非尼 胰腺萎缩 

分 类 号：R735.7[医药卫生—肿瘤]