摘要目的 研究西罗莫司对原发性肝细胞癌肝移植患者远期生存的影响.方法 回顾性分析2005年2月至2012年3月165例原发性肝细胞癌肝移植患者的临床资料.患者按是否加用西罗莫司分为两个队列:对照组71例,初始免疫抑制方案为FK506+霉酚酸酯+甲泼尼龙,维持期免疫抑制方案为FK506基础上酌情加用霉酚酸酯;西罗莫司组94例,初始免疫抑制方案为FK506+西罗莫司或霉酚酸酯+甲泼尼龙,维持期免疫抑制方案为FK506+西罗莫司.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81例,死亡18例,其中肿瘤复发死亡14例;西罗莫司组94例,死亡16例,其中肿瘤复发死亡10例.对照组和西罗莫司组术后1、2、3、5年的生存率分别为87％比97％ (P =0.03)、80％比88％、76％比85％、63％比75％,术后1、2、3、5年肿瘤复发率分别为12％比3％、17％比9％、21％比9％(P=0.04)、31％比16％ (P =0.03).早中期肝细胞癌(Ⅰ～Ⅱ期)共131例(对照组61例,西罗莫司组70例),术后1、2、3、5年生存率分别为90％比97％、80％比90％、78％比86％、65％比82％ (P =0.04),术后1、2、3、5年肿瘤复发率分别为10％比3％、16％比8％、18％比8％、29％比11％ (P=0.01).结论 西罗莫司能够降低早中期肝细胞癌肝移植术后远期肿瘤复发率并提高其术后生存率.

abstractsObjective To evaluate the influence of sirolimus on the long-term survival of patients after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC).Methods Clinic data of 165 consecutive patients who underwent OLT for HCC from February 2005 to March 2012 was analyzed retrospectively.Among them,94 patients were treated with a sirolimus-based immunosuppressive protocol after OLT,while the other 71 patients with a FK506-based protocol.Postoperative survival time,survival,disease-free survival (DFS) and tumor recurrence rates between the two groups were compared.Results The 2 groups were comparable in all clinicopathologic parameters.The sirolimus-based group had higher patient survival rates than the control group at 1-year (87％ vs.97％,P =0.03),2-year (80％ vs.88％),3-year (76％ vs.85％) and 5-year (63％ vs.75％).The 1-year,2-year,3-year and 5-year recurrence rates were 12％ vs.3％,17％ vs.9％,21％ vs.9％ (P=0.04) and 31％ vs.16％ (P=0.03).Early and mid-HCC (Ⅰ-Ⅱ stage) of 131 cases (control group 61 cases,sirolimus-based group of 70 patients).The 1-year,2-year,3-year and 5-year survival rates were 90％ vs.97％,80％ vs.90％,78％ vs.86％ and 65％ vs.82％ (P =0.04) and recurrence rates were 10％ vs.3％,16％ vs.8％,18％ vs.8％ and 29％ vs.11％ (P =0.01).Conclusion The sirolimus-based immunosuppressive protocol reduce long-term postoperative recurrence rate and improve the survival rate of patients after OLT for HCC significantly (especially early-mid HCC).