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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

王媒西 赵圆圆 杨博 魏来 陈栋 蒋继贫 陈知水

王媒西, 赵圆圆, 杨博, 等. 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[J]. 器官移植, 2021, 12(3): 302-308. doi: 10.3969/j.issn.1674-7445.2021.03.008
引用本文: 王媒西, 赵圆圆, 杨博, 等. 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[J]. 器官移植, 2021, 12(3): 302-308. doi: 10.3969/j.issn.1674-7445.2021.03.008
Wang Meixi, Zhao Yuanyuan, Yang Bo, et al. Comparison of clinical efficacy of different anti-tumor therapies for recurrence and metastasis after liver transplantation for liver cancer[J]. ORGAN TRANSPLANTATION, 2021, 12(3): 302-308. doi: 10.3969/j.issn.1674-7445.2021.03.008
Citation: Wang Meixi, Zhao Yuanyuan, Yang Bo, et al. Comparison of clinical efficacy of different anti-tumor therapies for recurrence and metastasis after liver transplantation for liver cancer[J]. ORGAN TRANSPLANTATION, 2021, 12(3): 302-308. doi: 10.3969/j.issn.1674-7445.2021.03.008

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

doi: 10.3969/j.issn.1674-7445.2021.03.008
基金项目: 

国家自然科学基金 81770652

湖北省技术创新专项重大项目 2017ACA096

详细信息
    作者简介:

    王媒西,女,博士,住院医师,研究方向为肝移植,Email: 584913263@qq.com

    通讯作者:

    陈知水,男,博士,主任医师,研究方向为肝移植,Email: zschen@tjh.tjmu.edu.cn

  • 中图分类号: R617, R735.7

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

More Information
  • 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。

     

  • 图  1  肝癌肝移植术后复发转移受者的生存分析

    注:A图为接受抗肿瘤治疗与未接受抗肿瘤治疗受者的生存分析;B图为接受不同抗肿瘤治疗受者的生存分析。

    Figure  1.  Survival analysis of recipients with recurrence and metastasis after liver transplantation for liver cancer

    表  1  接受不同抗肿瘤治疗方法的受者的临床特征比较

    Table  1.   Comparison of clinical characteristics of recipients with different anti-tumor therapies

    变量 靶向药物治疗(n=24) 其他抗肿瘤治疗(局部治疗、放疗及化疗)(n=20) 未接受抗肿瘤治疗(n=20) P
    年龄[MQ25Q75),岁] 53(40, 58) 49(41, 55) 51(39, 54) 0.703
    性别[n(%)] 0.374
      男 21(88) 20(100) 19(95)
      女 3(12) 0(0) 1(5)
    原发病[n(%)] 0.154
      乙肝后肝癌 20(83) 19(95) 20(100)
      酒精性肝病后肝癌 1(4) 1(5) 0(0)
      其他原因肝癌 3(12) 0(0) 0(0)
    术前MELD评分[MQ25Q75),分] 7(5, 16) 6(4, 9) 9(4, 19) 0.425
    术前AFP[MQ25Q75),ng/mL] 83(10, 10 512) 2 000(17, 10 144) 717(63, 20 931) 0.502
    肿瘤数量[n(%)] 0.324
      单发 14(58) 10(50) 5(25)
      多发 10(42) 10(50) 15(75)
    最大肿瘤直径[MQ25Q75),cm] 5(3, 9) 5(3, 8) 5(3, 10) 0.602
    有血管侵犯[n(%)] 9(38) 11(55) 9(45) 0.230
    米兰标准内[n(%)] 6(25) 7(35) 4(20) 0.528
    杭州标准内[n(%)] 9(38) 8(40) 8(40) 0.981
    术前抗肿瘤治疗[n(%)] 0.379
      未治疗 6(25) 7(35) 9(45)
      TACE或射频消融 18(75) 13(65) 11(55)
    病理分化[n(%)] 0.649
      高 2(8) 0(0) 0(0)
      中 11(46) 7(35) 8(40)
      低 10(42) 11(55) 9(45)
      坏死 1(4) 2(10) 3(15)
    术后复发时间[MQ25Q75),月] 6(3, 10) 6(3, 9) 5(2, 12) 0.962
    复发转移部位[n(%)]
      移植肝 6(25) 3(15) 1(5) 0.195
      肺 8(33) 4(20) 3(15) 0.427
      骨 0(0) 1(5) 2(10) 0.286
      其他 10(42) 12(60) 14(70) 0.155
    注:①MELD为终末期肝病模型。
    下载: 导出CSV
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  • 收稿日期:  2021-01-03
  • 网络出版日期:  2021-05-19
  • 刊出日期:  2021-05-15

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