钙调磷酸酶抑制剂在肝移植后肝癌进展中的作用

O. Olisov, M. Novruzbekov, V. Gulyaev, K. Lutsyk
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摘要

介绍。原位肝移植是治疗肝细胞癌最根治的方法。高复发率限制了移植在肝细胞癌患者中的应用。免疫抑制治疗可能影响肝移植后肿瘤进展的频率。目的探讨免疫抑制治疗在肝移植后肝癌患者术后进展中的作用。分析104例肝移植术后肝细胞癌复发率及无瘤生存率。为了评估免疫抑制主要成分浓度对肝细胞癌术后进展的影响,我们研究了无瘤期患者整个随访期的平均基线浓度(C0)和进展期肝细胞癌患者的平均基线浓度,其中仅研究无瘤期的持续时间。根据肿瘤病变程度,根据米兰标准(基于受者移植肝脏的病理和形态学检查结果)对患者进行分布。他克莫司基线血药浓度>6.0 ng/ml和环孢素A>100 ng/ml与肝细胞癌的高进展率相关。减少钙调磷酸酶抑制剂的负荷可以减少癌症进展的发生率至少2倍。晚期肿瘤患者的1年、3年和5年无复发生存率以及基线血钙调磷酸酶抑制剂水平较低的患者分别为82%、70%和70%。最大限度地减少免疫抑制对于预防肝细胞癌移植后进展至关重要,特别是在常见形式的患者中。
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The role of calcineurin inhibitors in the progression of hepatocellular carcinoma after liver transplantation
Introduction. Orthotopic liver transplantation is the most radical method of treatment of hepatocellular carcinoma. The high recurrence rate limits the use of transplantation in patients with hepatocellular cancer. Immunosuppressive therapy may affect the frequency of oncoprogression after liver transplantationAim. To evaluate the role of immunosuppressive therapy in the postoperative progression of hepatocellular cancer in patients after liver transplantationMaterial and methods. The recurrence rate of hepatocellular cancer and tumor free survival in 104 patients after liver transplantation were analyzed. To evaluate the effect of the immunosuppression main component concentration on the postoperative progression of hepatocellular carcinoma, we studied the mean baseline concentration (C0) for the entire follow-up period for patients with a tumor-free period and the mean baseline concentration for patients with hepatocellular carcinoma progression, in whom only the duration of the tumor-free period was studied. According to the degree of tumor lesion, patients were distributed in accordance with the Milan criteria (based on the results of a pathologic and morphological examination of the recipient's explanted liver.Results. The values of the baseline blood level of tacrolimus>6.0 ng/ml and cyclosporine A>100 ng/ml is associated with a high rate of progression of hepatocellular cancer. Reducing the load of calcineurin inhibitors can reduce the incidence of cancer progression by at least 2 times. The values of 1-, 3- and 5-year relapse-free survival in patients with advanced cancer and low figures of the baseline blood level of calcineurin inhibitor are 82%, 70% and 70%, respectively.Conclusion. Minimization of immunosuppression is of crucial importance in the prevention of posttransplant progression of hepatocellular cancer, especially among patients with its common form.
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