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目的探讨西罗莫司对超米兰标准肝细胞癌(肝癌)肝移植患者生存预后的影响。方法回顾性分析2006年1月至2011年1月在中山大学附属第三医院肝移植中心行肝移植且接受完整随访的70例超米兰标准肝癌患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。其中男66例,女4例;年龄21~69岁,中位年龄46岁。根据有否联用西罗莫司将患者分为对照组(40例)和西罗莫司组(30例)。对照组采用他克莫司(FK506)或环孢素(CsA)+甲泼尼龙二联免疫抑制方案。西罗莫司组术后15~30 d,在二联免疫抑制方案基础上加用西罗莫司,并逐步减量至停用FK506或CsA。对照组复发患者中15例复发后改用西罗莫司,12例继续原免疫抑制方案;西罗莫司组复发患者继续应用西罗莫司。生存分析采用Kaplan-Meier法和Log-rank检验。结果西罗莫司组无瘤生存率为23%,对照组为46%,两组无瘤生存率比较差异无统计学意义(χ2=1.41,P>0.05)。应用西罗莫司的复发患者带瘤生存时间为4~34个月,中位时间12个月;未应用西罗莫司复发患者带瘤生存时间为3~22个月,中位时间9个月;带瘤生存时间比较差异有统计学意义(χ2=6.30,P<0.05)。结论西罗莫司可以改善超米兰标准肝癌肝移植患者的生存预后,延长带瘤生存时间。
Objective To investigate the effect of sirolimus on the survival and prognosis of patients with liver metastasis of super Milan standard hepatocellular carcinoma (HCC). Methods The clinical data of 70 patients with transmembrane HCC who underwent liver transplantation from January 2006 to January 2011 at the Third Affiliated Hospital of Sun Yat-sen University for liver transplantation were retrospectively analyzed. All patients signed informed consent, in line with medical ethics rules. There were 66 males and 4 females, aged from 21 to 69 years, with a median age of 46 years. Patients were divided into control group (40 cases) and sirolimus group (30 cases) according to the presence or absence of sirolimus. The control group received either tacrolimus (FK506) or cyclosporine (CsA) + methylprednisolone dual immunosuppression regimen. In the sirolimus group, sirolimus was added to the immunosuppressive regimen 15 to 30 days after operation and was gradually reduced to disable FK506 or CsA. In the control group, 15 patients relapsed after relapse to sirolimus, and 12 patients continued the original immunosuppressive regimen; patients with relapsed sirolimus continued to use sirolimus. Survival analysis using Kaplan-Meier method and Log-rank test. Results The tumor-free survival rate was 23% in the sirolimus group and 46% in the control group. There was no significant difference in the tumor-free survival between the two groups (χ2 = 1.41, P> 0.05). Patients with recurrence of sirolimus had a survival time of 4 to 34 months with a median time of 12 months; patients without recurrence of sirolimus had a survival time of 3 to 22 months with a median time of 9 months Month; tumor survival time difference was statistically significant (χ2 = 6.30, P <0.05). Conclusion Sirolimus can improve the survival prognosis of patients with liver metastasis exceeding standard Milan and prolong the survival time of tumor.