肝癌肝移植术后不同频次利卡汀治疗疗效和不良反应的比较

Efficacy and safety of licartin with repeated administration in treatment of HCC patients after livertransplantation

目的探讨肝癌肝移植术后患者接受不同频次利卡汀治疗的疗效和不良反应。方法回顾性分析天津市第一中心医院2012年12月至2016年12月60例原发性肝癌肝移植术后接受利卡汀治疗患者的临床资料。根据利卡汀治疗频次分为A组：单次治疗组（治疗1次，45例）和B组：多次治疗组（治疗≥2次，15例）。对治疗前1周、治疗后2、4和8周两组的血常规、肝功能及甲状腺功能进行比较，对比观察治疗后的疗效和不良反应。结果两组的性别、年龄、甲胎蛋白水平等差异均无统计学意义（均P〉0．05）。与治疗前1周的基线水平相比，两组治疗后2周血小板计数减少，8周时恢复到基线水平（F=50．42和61．71，P〈0．05）；治疗后4周丙氨酸移氨酶和总胆红素均有一定程度增高，8周时恢复到基线水平（F=5．42和3．39、8．95和6．84，均P〈0．05）；甲状腺功能损伤者所占比例分别为8．9％和8．6％。两组均无严重不良反应发生，治疗后短期内各种轻微不良反应可自行缓解或对症处理后消失，组间差异无统计学意义（X。=0．459～1．0，均P〉0．05）。A组中位生存期为34．0个月，移植后6、12、18、24、36、48个月的累计生存率分别为93．3％、86．6％、73．3％、62．2％、48．9％、33．3％；B组移植后6、12、18、24、36、48个月的累计生存率分别为100％、93．3％、86．7％、80．0％、66．7％、66．7％，组间对比差异有统计学意义（X。：4．324，P=0．038）。两组肝癌原位复发率分别为15．6％和13．3％（x。=1．0，P=0．601），肝外转移的发生率分别为22．2％和20．0％（x。=1．0，P=0．585）。结论多次利卡汀治疗能够延长肝癌肝移植患者的生存期，同时具有良好的安全性。

Objective To evaluate the efficacy and adverse reactions of licartin with repeated administration in treatment of hepatocellular carcinoma （HCC） patients after liver transplantation. Methods Clinical data of 60 patients after liver transplantation with licartin in Tianjin First Central Hospital from December 2012 to December 2016 were collected and analyzed. The patients were divided into A group （ received single therapy, n = 45 ） and B group （ received repeated therapy with equal or greater than twice, n = 15 ）. The results of blood routine examination, liver function and thyroid function between the two groups （1 week before treatment, 2,4 and 8 weeks after treatment） were compared. Survival time and adverse reactions were statistically analyzed. Results There was no significant statistical difference on age, gender and AFP between the two groups （all P 〉 0.05 ）. Compared to baseline level 1 week before treatment, platelet levels were reduced 2 weeks after treatment, and gradually recovered to baseline level at 8 weeks （F=50. 42 and 61.71, all P 〈 0. 05）;4 weeks after treatment, the alanine aminotransferase and total bilirubin levels were increased to a certain extent and recovered to baseline at 8 weeks（ F = 5.42 and 3.39, 8.95 and 6. 84, all P 〈0. 05）. Thyroid function iniury ratio for the two groups were 8. 9% and 8.6%. Noserious adverse reactions occurred, and mild adverse reactions could be tolerated with spontaneous remission or symptomatic treatment. There was no significant statistical difference between the two groups（ X2 ---0. 459 - 1.0, all P 〉0.05）. The median survival time was 34. 0 months for A group, the 6-, 12-, 18-, 24-, 36- and 48-month overall survival rates for the two groups were 93.3% , 86. 6% , 73.3%, 62. 2%, 48. 9% , 33.3% and 100% , 93.3% , 86. 7% , 80. 0%, 66. 7%, 66.7% , respectively （ ~2 = 4. 324, P = 0. 038 ）. I-ICC in situ recurrence rate for the two groups were 15.6% and 13.3% （ X2 = 1.0, P = 0. 601 ）. The incidence of hepatocellular metastasis for the two groups were 22. 2% and 20. 0% （ ~2 = 1.0, P = 0. 585 ）. Conclusion Repeated licartin administration could prevent HCC recurrence and prolong survival with satisfactory safety.