探讨索拉非尼在预防肝细胞癌（肝癌）肝移植患者术后肿瘤复发中的临床价值。

本前瞻性研究对象为2010年3月至2012年7月在郑州人民医院肝胆胰腺外科行肝移植术，且超出加州大学旧金山分校（UCSF）标准的41例肝癌患者。所有患者均签署知情同意书，符合医学伦理学规定。其中男35例，女6例；年龄34～61岁，中位年龄49岁。按照患者自主选择是否术后应用索拉非尼，将患者分为索拉非尼组（9例）和对照组（32例）。索拉非尼组患者服用索拉非尼, 400 mg口服，每日2次；患者不能耐受不良反应时，调整为半量服用（200 mg口服，每日2次）。对照组患者术后未服用索拉非尼或肿瘤复发后改索拉非尼治疗。术后患者接受随访，随访期间记录患者肿瘤复发和存活情况。两组患者术后肿瘤复发率比较采用χ²检验，术后1、2年无瘤生存率和累积生存率比较采用Kaplan-Meier法和Log-rank检验。

索拉非尼组患者术后肿瘤复发率3/9，其中2例为索拉非尼半量服用者。对照组患者术后肿瘤复发率47%（15/32），其中3例肝转移瘤行射频消融, 2例肺转移瘤行放射治疗（放疗）, 2例肺转移瘤口服索拉非尼，其他8例多发转移未行治疗。两组患者肿瘤复发率比较差异无统计学意义（χ²=0.523, P>0.05）。索拉非尼组患者无发生死亡，对照组12例死于肿瘤复发、转移。索拉非尼组和对照组患者术后2年无瘤生存率分别为67%、53%，差异无统计学意义（χ²=2.226, P>0.05）；术后2年累积生存率分别为100%、63%，差异有统计学意义（χ²=5.126, P<0.05）。

索拉非尼能提高超出UCSF标准肝癌肝移植患者的2年累积生存率，对预防术后肿瘤复发有一定价值。

To investigate the clinical value of sorafenib in preventing tumor recurrence in patients with hepatocellular carcinoma (HCC) after liver transplantation (LT).

A total of 41 patients with HCC beyond University of California, San Francisco (UCSF) criteria receiving LT in Department of Hepatobiliary Pancreatic Surgery, People's Hospital of Zhengzhou from March 2010 to July 2012 were enrolled in this prospective study. The informed consents of all patients were obtained and the ethical committee approval was received. There were 35 males and 6 females with age ranging from 34 to 61 years old and the median age of 49 years old. According to whether the patients chose sorafenib for treatment after operation, they were divided into sorafenib group (n=9) and control group (n=32). Patients were treated with sorafenib orally (400 mg) twice daily in sorafenib group, and half dose (200 mg) was given twice daily when the patients were intolerant to the adverse reactions. In control group, patients did not take sorafenib or changed to take sorafenib after tumor recurrence. Patients received follow-up after operation, and tumor recurrence and survival were recorded during the follow-up. The tumor recurrence rates after operation of two groups were compared using Chi-squane test. The postoperative 1-, 2-year disease-free survival and cumulative survival rates were compared using Kaplan-Meier method and Log-rank test.

The tumor recurrence rate was 3/9 in sorafenib group including 2 cases of taking half dose sorafenib. The tumor recurrence rate was 47% (15/32) in control group including 3 cases with liver metastasis underwent radiofrequency ablation, 2 cases with pulmonary metastases underwent radiation therapy, 2 cases with pulmonary metastases took sorafenib, the other 8 cases with multiple metastases received no treatments. No significant difference was observed in tumor recurrence rates between two groups (χ²=0.523, P>0.05). No death was observed in sorafenib group, while in control group, 12 cases died of tumor recurrence or metastasis. The postoperative 2-year disease-free survival rates were 67%, 53% in sorafenib group and control group respectively and no significant difference was observed (χ²=2.226, P>0.05). The postoperative 2-year cumulative survival rates were 100%, 63% in sorafenib group and control group respectively and significant difference was observed (χ²=5.126, P<0.05).

For patients with HCC beyond UCSF criteria after LT, sorafenib can improve the 2-year cumulative survival rate and has a certain value in preventing tumor recurrence after operation.