mTOR抑制剂对预防肝癌肝移植术后肿瘤复发的疗效分析

Efficacy of sirolimus-based immunosuppression in patients with hepatocellular carcinoma after liver transplantation

目的探讨分析西罗莫司对预防肝癌肝移植术后肿瘤复发的疗效。方法回顾性分析2016年1月1日至2018年12月31日在华中科技大学同济医学院附属同济医院因原发性肝细胞癌行肝移植的114例受者资料,根据免疫抑制方案中是否应用西罗莫司分为西罗莫司组(63例)和他克莫司组(51例)。应用单因素和多因素回归分析肝癌复发的危险因素,Cox回归分析评估西罗莫司对受者无瘤生存时间的影响。结果45例发生了肿瘤的复发和(或)转移。单因素和多因素回归分析表明,使用西罗莫司是预防肿瘤复发的独立保护因素[P=0.005,HR=0.38,95%置信区间(CI):0.193~0.748]。他克莫司组受者无瘤生存时间为5个月(4~19个月),而西罗莫司组的受者的无瘤生存时间为23个月(13~31个月)。两组发生感染及排斥反应概率的差异无统计学意义(P>0.05)。结论肝癌肝移植术后免疫抑制方案以雷帕霉素靶蛋白(mTOR)抑制剂西罗莫司为主的受者可能比钙调神经磷酸酶抑制剂(CNI)他克莫司为主的受者肿瘤复发率更低,无瘤生存时间更长。

Objective To explore the efficacy of sirolimus-based immunosuppressive protocol on tumor recurrence and tumor-free survival after liver transplantation(LT)in hepatocellular carcinoma(HCC)patients.Methods From January 1,2016 to December 31,2018,a total of 114 HCC patients undergoing LT were recruited and divided into two groups of sirolimus(SRL)and tacrolimus.Univariate and multivariant analyses were performed for evaluating the risk factors of recurrence after LT.Tumor-free survival were compared using Cox logistic regression analysis.Results Tumor recurrence and/or metastasis occurred in 45 patients.Univariate and multivariate regression analysis indicated that sirolimus was an independent protective factor for preventing tumor recurrence(P=0.005,HR=0.38,95%CI 0.193~0.748).The median tumor-free survival time was 5(4~19)months in tacrolimus group and 23(13~31)months in sirolimus group.No inter-group statistical difference existed in incidence of infection or rejection complications(P>0.05).Conclusions HCC patients benefit from sirolimus-based immunosuppressive protocol after LT.And sirolimus may reduce tumor recurrence rate and prolong tumor-free survival time.