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背景:移植后肿瘤复发是影响肝癌肝移植疗效的主要因素,如何防止肝癌肝移植后肿瘤复发是目前肝移植研究的热点问题之一。亚砷酸全身化疗被认为对中晚期肝癌具有一定作用,但在肝移植后的应用还未见报道。目的:观察超出米兰标准的肝癌患者肝移植后应用亚砷酸全身化疗的对肿瘤复发的干预效果。方法:对23例超出米兰标准的肝癌患者肝移植后采用亚砷酸行预防性化疗:静脉滴注10mg/d,连续使用7d后间隔7d,重复4次为1个疗程,患者接受1~4个疗程。观察以上使用亚砷酸化疗患者的生存、肿瘤复发情况,以及化疗不良反应,并与同期16例未使用化疗的肝癌肝移植患者相比较。结果与结论:经过3~32个月随访,共30例患者出现肝癌复发,化疗组16例,非化疗组14例,复发部位最常见于肺部、移植肝及骨骼。化疗组与非化疗组肿瘤复发率差异无显著性意义,但化疗组复发时间明显延迟(P=0.026);两组6个月、1年生存率差异无显著性意义,化疗组2年生存率显著高于非化疗组(P=0.037);两组6个月无瘤生存率差异无显著性意义,1年、2年无瘤生存率化疗组显著高于明显非化疗组(P=0.030,0.023)。亚砷酸使用过程中未发现严重不良反应。提示肝癌肝移植患者静脉使用亚砷酸化疗可以延迟肿瘤复发,提高生存率。
BACKGROUND: Tumor recurrence after transplantation is a major factor affecting the efficacy of liver transplantation for liver cancer. How to prevent tumor recurrence after liver transplantation is one of the hot issues in liver transplantation. Arsenious acid systemic chemotherapy is considered to have a role in the treatment of advanced liver cancer, but the application after liver transplantation has not been reported. OBJECTIVE: To observe the intervention effect of systemic chemotherapy with arsenic trioxide on tumor recurrence after liver transplantation beyond the standard of Milan. Methods: Twenty-three patients with liver cancer beyond Milan criteria were treated with prophylactic chemotherapy with arsenite after intravenous infusion of 10 mg / d, 7 days after continuous use for 7 days, 4 times as a course of treatment and 1 to 4 patients A course of treatment. To investigate the survival, tumor recurrence, and adverse reactions of chemotherapy in the above patients treated with arsenite, and compared with 16 patients with liver cancer who did not receive chemotherapy in the same period. RESULTS AND CONCLUSION: After 3 to 32 months of follow-up, a total of 30 patients had recurrence of HCC. There were 16 patients in the chemotherapy group and 14 patients in the non-chemotherapy group. The recurrence sites were most common in the lungs, liver and bone graft. There was no significant difference in tumor recurrence between chemotherapy group and non-chemotherapy group, but the recurrence time in chemotherapy group was significantly delayed (P = 0.026). There was no significant difference in 6-month and 1-year survival rate between two groups (P = 0.037). There was no significant difference between the two groups in 6-month disease-free survival rate. The 1-year and 2-year disease-free survival rates in the chemotherapy group were significantly higher than those in the non-chemotherapy group (P = 0.030, 0.023). No serious adverse reactions were observed during the use of arsenious acid. Prompt liver transplantation in patients with liver transplantation of arsenic acid chemotherapy can delay tumor recurrence and improve survival.