综合抗癌治疗在肝癌肝移植术后肺转移瘤中的疗效观察  

Efficacy of comprehensive anti-cancer treatment for lung metastasis after liver transplantation for hepatocellular carcinoma

作　　者：张骊[1] 贺健 谢炎 田大治[1] 陈池义 蒋文涛[1] Zhang Li;He Jian;Xie Yan;Tian Dazhi;Chen Chiyi;Jiang Wentao(Liver Transplantation Department,Tianjin First Center Hospital,Key Laboratory for Critical Care Medicine of the Ministry of Health,Tianjin Key Laboratory for Organ Transplantation,Tianjin Clinical Research Center for Organ Transplantation,Key Laboratory of Transplant Medicine,Chinese Academy of Medical Sciences,Tianjin 300070,China)

机构地区：[1]天津市第一中心医院移植外科,卫生部危重病急救医学重点实验室,天津市器官移植重点实验室,天津市器官移植临床医学研究中心,中国医学科学院移植医学重点实验室,300192

出　　处：《中华器官移植杂志》2021年第11期652-656,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金面上项目(81870444);天津市自然科学基金(19JCQNJC10300)。

摘　　要：目的评价综合抗癌治疗在肝癌肝移植术后肺转移瘤中的疗效。方法纳入2012年3月至2016年7月天津市第一中心医院36例肝癌肝移植术后肺转移瘤受者, 根据肺转移瘤的不同处理方式分为综合抗癌治疗组(雷帕霉素+放射性125I粒子植入术+肺动脉灌注化学药物治疗+索拉非尼)22例和维持支持治疗组14例, 评价两组受者的生存情况。结果两组受者移植术前的基本资料、肿瘤病理情况、术后发生肺转移瘤的时间、肺转移瘤肿瘤负荷无明显差异;综合抗癌治疗组治疗后部分缓解3例、疾病稳定12例、疾病进展7例, 维持支持治疗组治疗后疾病稳定3例、疾病进展11例, 综合抗癌治疗效果优于维持支持治疗(χ2=7.901, P=0.019);综合抗癌治疗组和维持支持治疗组肿瘤转移后中位生存时间分别为23个月(95%CI:19.68~26.32)和7个月(95%CI:3.33~10.67), 转移后1年存活率分别为91%和9%, 转移后2年存活率分别为45%和0, 转移后3年存活率分别为10%和0, 综合抗癌治疗组存活率明显优于维持支持治疗组(P<0.001)。结论对于肝癌肝移植术后的肺转移瘤受者采用雷帕霉素+放射性125I粒子植入术+肺动脉灌注化学药物治疗+索拉非尼的综合抗癌治疗可改善其生存时间。Objective To evaluate the efficacy of comprehensive anti-cancer treatment for lung metastases after liver transplantation(LT)for hepatocellular carcinoma(HCC).Methods From March 2012 to July 2016,A total of 36 patients with lung metastasis after LT were divided into comprehensive anti-cancer treatment group(rapamycin+radioactive I125 seed implantation+pulmonary artery infusion chemotherapy+sorafenib,n=22)and maintenance supportive care group(n=14).The survival profiles of two groups were evaluated.Results No significant inter-group differences existed in preoperative basic data,tumor pathology,time of pulmonary metastatic tumor after operation and lung metastasis tumor burden.In comprehensive anti-cancer treatment group,there were partial remission(n=3),disease stability(n=12)and disease progression after treatment(n=7).In maintenance supportive care group,there were disease stability(n=3)and disease progression after treatment(n=11).And comprehensive anti-cancer treatment was superior to maintenance supportive care(χ2=7.901,P=0.019).The median survival time after metastasis was 23 months(95%CI:19.68-26.32)in comprehensive anti-cancer treatment group and 7 months(95%CI:3.33-10.67)in maintenance supportive care group;1-year survival rate 91%and 9%,2-year survival rate 45%and 0%and 3-year survival rate 10%and 0%respectively.The survival rate of comprehensive anti-cancer treatment group was significantly better than that of maintenance supportive care group(P<0.001).Conclusions Comprehensive anti-cancer treatment(rapamycin+radioactive I125 seed implantation+pulmonary artery infusion chemotherapy+sorafenib)can improve the survival time of patients with lung metastasis after liver transplantation for HCC.

关 键 词：肝移植 肝细胞癌 肺转移性肿瘤 

分 类 号：R734.2[医药卫生—肿瘤] R735.7[医药卫生—临床医学]