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目的总结西罗莫司(SRL)在肾移植术后新发恶性肿瘤患者中的临床应用经验。方法对完成的2 000余例肾移植患者进行随访和统计,共发现在术后新发的恶性肿瘤15例,其中泌尿系统肿瘤6例(40%),呼吸系统肿瘤3例(20%),消化系统肿瘤3例(20%),卡波西肉瘤、子宫内膜癌和黑色素瘤各1例。在明确恶性肿瘤的诊断后,立即进行以SRL为主的免疫抑制方案的调整,并结合肿瘤的生物学特点再辅以手术和放化疗等治疗手段。结果在所有15例新发恶性肿瘤患者的随访中,有10例一直维持较好的生存状态,并且定期复查肾功能情况稳定。而另外5例患者在发现后2~42个月内死亡,但移植肾功能未见明显变化,且死亡患者中以肺癌、肝癌和前列腺癌较多见。结论在肾移植术后新发恶性肿瘤患者中,使用以SRL为主的免疫抑制方案可以取得稳定的肾功能的基础上,同时可控制或缓解恶性肿瘤的进展,但新发肿瘤的生物学特点仍是决定患者生存的主要因素。
Objective To summarize the clinical experience of sirolimus (SRL) in patients with newly diagnosed malignant tumors after renal transplantation. Methods A total of more than 2 000 renal transplant recipients were followed up and statistically analyzed. Fifteen newly diagnosed cases of malignant tumors were found, of which 6 were urologic tumors (40%), 3 (20%) were respiratory tumors, 3 cases of digestive system tumors (20%), Kaposi’s sarcoma, endometrial cancer and melanoma in 1 case. In the clear diagnosis of malignant tumors, immediately adjusted to SRL-based immunosuppressive regimens, combined with the biological characteristics of the tumor supplemented by surgery and radiotherapy and chemotherapy and other treatment. Results In all 15 cases of new malignant tumor follow-up, 10 cases have maintained a good survival status, and regular review of renal function and stability. The other 5 patients died within 2 to 42 months after their findings, but no significant changes were found in the function of renal allografts. Lung cancer, liver cancer and prostate cancer were more common in those who died. Conclusions In patients with newly diagnosed malignant tumors after renal transplantation, the use of SRL-based immunosuppressive regimen can achieve stable renal function and at the same time can control or alleviate the progress of malignant tumors. However, the biological characteristics of newly diagnosed tumors Still determine the survival of patients the main factor.