Sirolimus improves the survival of liver transplant patients with hepatocellular carcinoma exceeding the Milan criteria

doi:10.3877/cma.j.issn.2095-3232.2014.04.003

Abstract

Abstract:

Objective

To investigate the impact of sirolimus on the survival of liver transplant patients with hepatocellular carcinoma (HCC) exceeding the Milan criteria.

Methods

Clinical data of 70 patients with HCC exceeding the Milan criteria who underwent liver transplantation (LT) and received complete follow-up in Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University from January 2006 to January 2011 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. There were 66 males and 4 females with age ranging from 21 to 69 years and a median age of 46 years. According to whether sirolimus was combinedly used, the patients were divided into control group (n=40) and sirolimus group (n=30). Patients in control group were given a duplex immunosuppression regimen of tacrolimus (FK506) or cyclosporin A (CsA) + methylprednisolone. Patients in sirolimus group were given sirolimus on the basis of the duplex immunosuppression regimen 15-30 d after operation and FK506 or CsA was gradually reduced till stopped. In control group, 15 of the patients with tumor recurrence converted to use sirolimus, 12 cases maintained using the primary immunosuppression regimen. Patients with tumor recurrence in sirolimus group continued using sirolimus. The survival analysis was conducted using Kaplan-Meier method and the Log-rank test.

Results

The disease-free survival rate in sirolimus group was 23% and was 46% in control group. No significant difference was observed in the disease-free survival rate between two groups (χ²=1.41, P>0.05). The median tumor bearing survival length was 12 months (range: 4-34 months) for the patients with tumor recurrence who used sirolimus and was 9 months (range: 3-22 months) for patients who did not use sirolimus, where significant difference was observed between two groups (χ²= 6.30, P<0.05).

Conclusions

Sirolimus can improve the prognosis and prolong the tumor bearing survival length of liver transplant patients with HCC exceeding the Milan criteria.

Key words: Carcinoma, hepatocellular, Milan criteria, Liver transplantation, Sirolimus, Survival analysis, Disease-free survival

Shilei Xu, Qing Yang, Guoying Wang, Yingcai Zhang, Jian Zhang, Hua Li, Genshu Wang, Bo Liu, Yang Yang, Guihua Chen. Sirolimus improves the survival of liver transplant patients with hepatocellular carcinoma exceeding the Milan criteria[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2014, 03(04): 206-209.

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References 17

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组别	例数	性别		AFP(μg/L)		肿瘤直径（cm）		肿瘤数目		大血管侵犯		组织学分化程度（级）
组别	例数	男	女	≤400	> 400	≤10	> 10	单发	多发	无	有	Ⅰ～Ⅱ	Ⅲ～Ⅳ
西罗莫司组	30	29	1	19	11	14	16	6	24	13	17	23	7
对照组	40	37	3	23	17	21	19	11	29	22	18	35	5
χ²值	?	0.55		0.24		0.23		0.52		0.93		1.42
P值	?	> 0.05		> 0.05		> 0.05		> 0.05		> 0.05		> 0.05

组别	例数	性别		AFP(μg/L)		肿瘤直径（cm）		肿瘤数目		大血管侵犯		组织学分化程度（级）
组别	例数	男	女	≤400	> 400	≤10	> 10	单发	多发	无	有	Ⅰ～Ⅱ	Ⅲ～Ⅳ
西罗莫司组	30	29	1	19	11	14	16	6	24	13	17	23	7
对照组	40	37	3	23	17	21	19	11	29	22	18	35	5
χ²值	?	0.55		0.24		0.23		0.52		0.93		1.42
P值	?	> 0.05		> 0.05		> 0.05		> 0.05		> 0.05		> 0.05

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