不同抗肿瘤治疗方法对肝癌肝移植术后复发转移的疗效比较  

Comparison of clinical efficacy of different anti-tumor therapies for recurrence and metastasis after liver transplantation for liver cancer

作　　者：王媒西 赵圆圆 杨博[1] 魏来[1] 陈栋[1] 蒋继贫[1] 陈知水[1] Wang Meixi;Zhao Yuanyuan;Yang Bo;Wei Lai;Chen Dong;Jiang Jiping;Chen Zhishui(Organ Transplantation Institute,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Key Laboratory of Organ Transplantation of Ministry of Education,Key Laboratory of Organ Transplantation of National Health Commission of China,Key Laboratory of Organ Transplantation of Chinese Academy of Medical Sciences,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所,器官移植教育部重点实验室,国家卫生健康委员会器官移植重点实验室,中国医学科学院器官移植重点实验室,武汉430030

出　　处：《器官移植》2021年第3期302-308,共7页Organ Transplantation

基　　金：国家自然科学基金(81770652);湖北省技术创新专项重大项目(2017ACA096)。

摘　　要：目的分析不同抗肿瘤治疗方法对原发性肝癌(肝癌)肝移植术后复发转移的疗效。方法回顾性分析145例肝癌肝移植受者的临床资料。分析肝癌肝移植受者术后总体生存情况及复发转移情况。比较不同抗肿瘤治疗方法治疗复发转移受者的效果。结果65例受者(44.8%)发生了复发转移,中位复发时间为6个月。其中1例复发后再次行肝移植,因肠穿孔死亡;24例(37%)接受靶向药物治疗,中位带瘤生存期为22个月;11例(17%)接受放射治疗(放疗)或化学药物治疗(化疗),中位带瘤生存期为11个月;9例(14%)接受局部治疗(手术切除或射频消融),中位带瘤生存期为8个月;20例(31%)未接受抗肿瘤治疗,中位带瘤生存期为3个月。接受抗肿瘤治疗受者的带瘤生存期较未接受抗肿瘤治疗受者延长(P<0.001);接受靶向药物治疗受者的带瘤生存期较接受其他抗肿瘤治疗受者延长(P=0.03);接受局部治疗和放、化疗受者的带瘤生存期较未接受抗肿瘤治疗受者延长(P=0.004)。结论对于肝癌肝移植术后复发转移受者,首选手术切除和射频消融。对于无法接受局部治疗的多灶性肿瘤,使用靶向药物治疗的受者带瘤生存期最长,放、化疗亦能延长复发转移受者的生存期。Objective To analyze the clinical efficacy of different anti-tumor therapies for recurrence and metastasis after liver transplantation for primary liver cancer(liver cancer).Methods Clinical data of 145 recipients undergoing liver transplantation for liver cancer were retrospectively analyzed.The overall survival and recurrence and metastasis after liver transplantation for liver cancer were analyzed.The clinical efficacy of different anti-tumor therapies for recipients with recurrence and metastasis were compared.Results Sixty-five recipients(44.8%)developed recurrence and metastasis.The median recurrence time was 6 months.Among them,1 case underwent secondary liver transplantation after recurrence and died of intestinal perforation.Twenty-four recipients(37%)received targeted drug therapy with a median tumor-bearing survival of 22 months.Eleven recipients(17%)received radiotherapy or chemotherapy with a median tumor-bearing survival of 11 months.Nine recipients(14%)received local treatment(surgical resection or radiofrequency ablation),and the median tumor-bearing survival was 8 months.Twenty recipients(31%)abandoned antitumor therapy,and the median tumor-bearing survival was 3 months.The tumor-bearing survival of recipients receiving anti-tumor therapy was significantly longer than that of recipients without anti-tumor therapy(P<0.001).The tumorbearing survival of recipients receiving targeted drug therapy was significantly longer than that of those receiving other anti-tumor therapies(P=0.03).The tumor-bearing survival of recipients receiving local treatment,radiotherapy and chemotherapy was considerably longer than that of those who abandoned anti-tumor therapy(P=0.004).Conclusions Surgical resection and radiofrequency ablation are the optimal therapies for recipients with recurrence and metastasis after liver transplantation for liver cancer.For recipients with multi-focal tumors who fail to receive local treatment,those receiving targeted drug therapy obtain the longest survival.In addition,radiotherapy an

关 键 词：原发性肝癌 肝移植 复发转移 靶向药物治疗 局部治疗 放射治疗 化学药物治疗 射频消融 

分 类 号：R617[医药卫生—外科学] R735.7[医药卫生—临床医学]