肝癌肝移植术后脑转移的治疗经验  

Management experience of brain metastasis after liver transplantation for hepatocellular carcinoma

作　　者：李俊杰 潘澄 邓永林 蒋文涛 张雅敏 高伟 沈中阳 郑虹 Li Junjie;Pan Cheng;Deng Yonglin;Jiang Wentao;Zhang Yamin;Gao Wei;Shen Zhongyang;Zheng Hong(First Central Clinical College,Tianjin Medical University,Department of Liver Transplantation,First Central Clinical College,Tianjin Medical University,Tianjin 300192,China)

机构地区：[1]天津医科大学一中心临床学院天津市第一中心医院肝移植科,天津300192

出　　处：《中华器官移植杂志》2022年第1期30-33,共4页Chinese Journal of Organ Transplantation

基　　金：天津市自然科学基金(17JCQNJC128000)。

摘　　要：目的探讨肝移植术后肝癌脑转移的发病特点和预后影响因素。方法回顾性分析天津市第一中心医院2000年至2020年间17例肝移植术后出现肝癌脑转移的受者。所有受者原发病均为乙型肝炎肝硬化合并肝细胞癌。移植前肝癌均超过米兰标准。免疫抑制方案术后早期为巴利昔单抗+吗替麦考酚酯+钙调磷酸酶抑制剂(CNIs)+糖皮质激素,并逐步停用糖皮质激素及吗替麦考酚酯。3例受者肿瘤复发后接受了西罗莫司免疫治疗,并停用CNIs药物。其中1例同时使用索拉非尼抗肿瘤治疗。结果所有受者均合并其他脏器转移,包括16例肺转移(94.1%),5例骨转移(29.4%),6例肝转移(35.3%)。确诊脑转移后中位生存时间为7个月,1年累积存活率为29.4%。移植术后中位生存时间为14个月,1年累积存活率为64.7%。7例行脑转移灶切除手术受者中,2例术后1个月内死亡,死亡原因为脑出血。5例术后存活,最长存活时间为214个月,中位生存时间为9个月。结论肝癌肝移植术后脑转移预后差。但通过早发现及合理治疗,能够延长受者生存时间,甚至取得长期生存。脑转移多伴有肺转移,发现肺转移瘤则提示需要关注颅内的病变情况。Objective To explore the pathogenesis and prognostic factors of brain metastasis of hepatocellular carcinoma(HCC)after liver transplantation(LT).Methods Retrospective review was performed for 17 HCC cases with brain metastasis after liver transplantation from 2000 to 2020.All cases were diagnosed as hepatitis B cirrhosis complicated with HCC.All of them were beyond the Milan Criteria.The immunosuppressive regimen consisted of baliximab+mycophenolate mofetil+calcineurin inhibitors(CNIs)+corticosteroids in early postoperative period with a gradual tapering of corticosteroids and mycophenolate mofetil.Three patients received sirolimus immunotherapy after tumor recurrence and withdrew CNIs.One of three cases received sorafenib.Results Other organ involvements included lung metastasis(n=16,94.1%),bone metastasis(n=5,29.4%)and liver metastasis(n=6,35.3%).The median survival time after brain metastasis was 7 months and the 1-year cumulative survival rate 29.4%.The median survival time post-LT was 14 months and the 1-year cumulative survival rate 64.7%.Among 7 patients with a resection of brain metastasis,two deaths at Month 1 post-operation were due to cerebral hemorrhage.The longest survival time was 214 months and the median survival time 9 months.Conclusions The prognosis of brain metastasis post-LT remains poor.However,early detection and reasonable treatment can prolong patient survival time and even achieve long-term survival.Most brain metastases are accompanied by lung metastases.And the finding of lung metastatic tumor hints at a presence of intracranial lesions.

关 键 词：肝移植 肝细胞癌 颅内转移瘤 

分 类 号：R735.7[医药卫生—肿瘤]