mTOR抑制剂对预防肝癌肝移植术后肿瘤复发的疗效分析  

Efficacy of sirolimus-based immunosuppression in patients with hepatocellular carcinoma after liver transplantation

作　　者：王媒西 赵圆圆 魏来[1] 陈栋[1] 蒋继贫[1] 陈知水[1] Wang Meixi;Zhao Yuanyuan;Wei Lai;Chen Dong;Jiang Jipin;Chen Zhishui(Key Laboratory of Organ Transplantation,Institute of Organ Transplantation,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Key Laboratory of Organ Transplantation,National Health Commission,Key Laboratory of Organ Transplantation,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：《中华器官移植杂志》2021年第9期529-533,共5页Chinese Journal of 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：目的探讨分析西罗莫司对预防肝癌肝移植术后肿瘤复发的疗效。方法回顾性分析2016年1月1日至2018年12月31日在华中科技大学同济医学院附属同济医院因原发性肝细胞癌行肝移植的114例受者资料,根据免疫抑制方案中是否应用西罗莫司分为西罗莫司组(63例)和他克莫司组(51例)。应用单因素和多因素回归分析肝癌复发的危险因素,Cox回归分析评估西罗莫司对受者无瘤生存时间的影响。结果45例发生了肿瘤的复发和(或)转移。单因素和多因素回归分析表明,使用西罗莫司是预防肿瘤复发的独立保护因素[P=0.005,HR=0.38,95%置信区间(CI):0.193~0.748]。他克莫司组受者无瘤生存时间为5个月(4~19个月),而西罗莫司组的受者的无瘤生存时间为23个月(13~31个月)。两组发生感染及排斥反应概率的差异无统计学意义(P>0.05)。结论肝癌肝移植术后免疫抑制方案以雷帕霉素靶蛋白(mTOR)抑制剂西罗莫司为主的受者可能比钙调神经磷酸酶抑制剂(CNI)他克莫司为主的受者肿瘤复发率更低,无瘤生存时间更长。Objective To explore the efficacy of sirolimus-based immunosuppressive protocol on tumor recurrence and tumor-free survival after liver transplantation(LT)in hepatocellular carcinoma(HCC)patients.Methods From January 1,2016 to December 31,2018,a total of 114 HCC patients undergoing LT were recruited and divided into two groups of sirolimus(SRL)and tacrolimus.Univariate and multivariant analyses were performed for evaluating the risk factors of recurrence after LT.Tumor-free survival were compared using Cox logistic regression analysis.Results Tumor recurrence and/or metastasis occurred in 45 patients.Univariate and multivariate regression analysis indicated that sirolimus was an independent protective factor for preventing tumor recurrence(P=0.005,HR=0.38,95%CI 0.193~0.748).The median tumor-free survival time was 5(4~19)months in tacrolimus group and 23(13~31)months in sirolimus group.No inter-group statistical difference existed in incidence of infection or rejection complications(P>0.05).Conclusions HCC patients benefit from sirolimus-based immunosuppressive protocol after LT.And sirolimus may reduce tumor recurrence rate and prolong tumor-free survival time.

关 键 词：肝移植 肝癌 钙调神经蛋白抑制剂 

分 类 号：R735.7[医药卫生—肿瘤]