超米兰标准肝癌肝移植术后肿瘤复发的综合治疗与局部治疗的疗效比较

肝癌电子杂志 ›› 2021, Vol. 8 ›› Issue (3): 12-16.

超米兰标准肝癌肝移植术后肿瘤复发的综合治疗与局部治疗的疗效比较

谢炎, 张炜琪, 孙纪三, 蒋文涛^*

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/天津市器官移植重点实验室/中国医学科学院移植医学重点实验室,天津 300070

收稿日期:2021-04-04 出版日期:2021-09-30 发布日期:2021-10-20
通讯作者: 蒋文涛,E-mail:jiangwentao@nankai.edu.cn
作者简介:谢炎主治医师, 天津市第一中心医院器官移植中心, 肝移植科
基金资助:
国家自然科学基金（81870444）; 天津市自然科学基金（20JCYBJC01010）; 天津市卫生健康委员会面上项目（ZC20100）

Comparison of comprehensive therapy and local therapy of recurrence after liver transplantation in patients with hepatocellular carcinoma beyond Milan criteria

Xie Yan, Zhang Weiqi, Sun Jisan, Jiang Wentao

Tianjin Medical University First Center Clinical College/Department of Liver Transplantation, Tianjin First Center Hospital/Tianjin Key Laboratory for Organ Transplantation/Key Laboratory of Transplantation Medicine, Chinese Academy of Medical Sciences,Tianjin 300070, China

Received:2021-04-04 Online:2021-09-30 Published:2021-10-20

摘要/Abstract

摘要： 目的: 比较不同治疗方式对超米兰标准肝癌肝移植术后复发肿瘤的疗效。方法: 回顾性分析天津市第一中心医院2016年3月至2019年8月接受首次原位肝移植手术且术后肿瘤复发的57例超米兰标准肝细胞癌患者的临床资料。根据患者复发后治疗方式的不同,将患者分为综合治疗组和局部治疗组。局部治疗包括手术切除、经肝动脉介入化疗栓塞、放射性¹³¹I粒子植入、动脉灌注化疗、射频消融、放疗等,综合治疗是在局部治疗的基础上加用索拉菲尼或仑伐替尼。比较分析综合治疗与局部治疗对患者肿瘤缓解与生存情况的差异。结果: 局部治疗组分别有1例（4.35%）和8例（34.78%）实现部分缓解和疾病稳定,14例（60.87%）患者在治疗后肿瘤发生进展。综合治疗组7例（20.59%）患者在治疗后达到局部缓解,17例(50%)患者实现疾病稳定,10例（29.41%）患者在治疗后肿瘤进展,疗效优于局部治疗组（P<0.05）。综合治疗组患者复发后中位生存时间为12个月,长于局部治疗组的7个月（P<0.01）。在综合治疗组里,仑伐替尼组和索拉菲尼组分别有3例（15.79%）、9例（47.37%）、7例（36.84%）和4例（26.67%）、8例（53.33%）、3例（20.00%）实现局部缓解、疾病稳定、疾病进展,两组在肿瘤缓解方面差异无统计学意义（P=0.548）。但仑伐替尼组的患者复发后中位生存时间（13个月）高于索拉菲尼组（10个月)（P<0.05）。结论: 超米兰标准肝癌肝移植术后肿瘤复发的患者更能从联合多种治疗方案的综合治疗中获益。在综合治疗方案里,仑伐替尼对于此类患者的长期生存可能优于索拉菲尼。

关键词: 肝癌肝移植, 超米兰标准, 术后复发, 综合治疗

Abstract: Objective: To compare the efficacy of different treatments of recurrence after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) beyond Milan criteria (MC). Methods: The clinical data of 57 patients with HCC beyond MC who underwent LT for the first time and had tumor recurrence after operation in Tianjin First Central Hospital from March, 2016 to August, 2019 were analyzed retrospectively. According to the different treatment methods after recurrence, the patients were divided into comprehensive treatment group and local treatment group. Local treatment includes surgical resection, transarterial chemoembolization, radioactive ¹³¹I seed implantation, arterial infusion chemotherapy, radiofrequency ablation and radiotherapy. The comprehensive treatment is the addition of sorafenib or lenvatinib on the basis of local treatment. The differences of tumor remission and survival between comprehensive treatment group and local treatment group were compared and analyzed. Results: In the local treatment group, 1 patient (4.35%) and 8 patients (34.78%) achieved partial remission (PR) and stable disease (SD) respectively, and 14 patients (60.87%) happened progressive disease (PD) after treatment. In the comprehensive treatment group, 7 patients (20.59%) achieved PR, 17 patients (50%) achieved SD, and 10 patients (29.41%) had PD after treatment, which was better than that of local treatment group (P < 0.05). The median survival timeafterrecurrencein the comprehensive treatment group was 12 months, which was higher than that in the local treatment group (7 months) (P < 0.01). In the comprehensive treatment group, 3 patients (15.79%), 9 patients (47.37%) and 7 patients (36.84%) achieved PR, SD and PD in lenvatinib respectively. In sorafenib group, 4 patients (26.67%), 8 patients (53.33%) and 3 patients (20.00%) achieved PR, SD and PD, respectively. There was no significant difference in tumor remission between the two groups (P=0.548). However, the median survival time after recurrence in the lenvatinib group (13 months) was higher than that in the sorafenib group (10 months) (P=0.047). Conclusion: Patients with tumor recurrence after LT for HCC beyond MC are more likely to benefit from the comprehensive treatment, in which lenvatinib may be sorafenib to sorafinib in the long-term survival of such patients.

Key words: Liver transplantation for liver cancer, Beyond Milan criteria, Postoperative recurrence, Comprehensive treatment

谢炎, 张炜琪, 孙纪三, 蒋文涛. 超米兰标准肝癌肝移植术后肿瘤复发的综合治疗与局部治疗的疗效比较[J]. 肝癌电子杂志, 2021, 8(3): 12-16.

Xie Yan, Zhang Weiqi, Sun Jisan, Jiang Wentao. Comparison of comprehensive therapy and local therapy of recurrence after liver transplantation in patients with hepatocellular carcinoma beyond Milan criteria[J]. Electronic Journal of Liver Tumor, 2021, 8(3): 12-16.

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