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目的探讨雷帕霉素对符合米兰标准的肝细胞癌(HCC)肝移植患者生存的影响。方法回顾性分析2004年11月至2012年1月北京佑安医院移植中心收治的90例符合米兰标准的HCC肝移植患者的临床资料。按患者是否加用雷帕霉素分为两组。对照组45例,初始免疫抑制方案为:他克莫司(FK506)+吗替麦考酚酯(MMF)+甲泼尼龙(Pred);维持期免疫抑制方案为:FK506+/-MMF。雷帕霉素组45例,初始免疫抑制方案同对照组;维持期免疫抑制方案为:FK506+雷帕霉素。比较两组患者术后生存时间、生存率、无瘤生存率和肿瘤复发率。结果至随访结束时,对照组45例,死亡11例,其中因肿瘤复发死亡9例;雷帕霉素组45例,死亡4例,其中因肿瘤复发死亡2例。对照组术后平均生存时间(72.6±5.8)月,明显低于雷帕霉素组[(84.0±4.0)月,差异有统计学意义(P<0.05)。对照组和雷帕霉素组术后1、2、3、5年的生存率分别为86.5%和97.8%(P=0.11),76.5%和97.8%(P<0.05),73.6%和91.2%(P=0.06),73.6%和87.0%(P=0.20);术后1、2、3、5年的无瘤生存率分别为81.6%和97.7%(P<0.05),73.7%和97.7%(P<0.05),73.7%和88.1%(P=0.15),73.7%和88.1%(P=0.15);术后1、2、3、5年的肿瘤复发率分别为13.3%和2.2%(P=0.11),18.6%和2.2%(P<0.05),21.6%和2.2%(P<0.05),21.6%和6.8%(P=0.06)。结论雷帕霉素能够显著提高符合米兰标准的HCC患者肝转移术后生存时间,降低肿瘤复发率并提高其术后生存率。
Objective To investigate the effect of rapamycin on the survival of patients with hepatocellular carcinoma (HCC) who meet the Milan criteria. Methods The clinical data of 90 patients with HCC liver transplantation meeting Milan criteria from November 2004 to January 2012 in Beijing You’an Hospital Transplantation Center were retrospectively analyzed. According to whether patients with rapamycin is divided into two groups. Control group of 45 cases, the initial immunosuppressive programs: tacrolimus (FK506) + mycophenolate mofetil (MMF) + methylprednisolone (Pred); maintenance phase immunosuppressive regimen: FK506 +/- MMF. 45 cases of rapamycin group, the initial immunosuppressive regimen with the control group; maintenance immunosuppression program: FK506 + rapamycin. The survival time, survival rate, tumor-free survival rate and tumor recurrence rate were compared between the two groups. Results At the end of the follow-up period, there were 45 cases in the control group, 11 died, of which 9 died of tumor recurrence; 45 cases of rapamycin and 4 died, of which 2 died of tumor recurrence. The mean postoperative survival time (72.6 ± 5.8) months in the control group was significantly lower than that in the rapamycin group [(84.0 ± 4.0) months, the difference was statistically significant (P <0.05). Survival rates at 1, 2, 3 and 5 years in the control and rapamycin groups were 86.5% and 97.8% (P = 0.11), 76.5% and 97.8% (P <0.05), 73.6% and 91.2% (P = 0.06), 73.6% and 87.0% respectively (P = 0.20). The tumor-free survival rates at 1, 2, 3 and 5 years were 81.6% and 97.7% (P <0.05), 73.7% and 88.1% (P = 0.15), 73.7% and 88.1% (P = 0.15) respectively. The tumor recurrence rates at 1, 2, 3 and 5 years were 13.3% and 2.2% P = 0.11), 18.6% and 2.2% (P <0.05), 21.6% and 2.2% (P <0.05), 21.6% and 6.8% (P = 0.06). Conclusion Rapamycin can significantly improve the survival time, reduce the recurrence rate and increase the postoperative survival rate of patients with HCC meeting the Milan criteria.