Assessing the role of everolimus in reducing hepatocellular carcinoma recurrence after living donor liver transplantation for patients within the UCSF criteria: re-inventing the role of mammalian target of rapamycin inhibitors
Assessing the role of everolimus in reducing hepatocellular carcinoma recurrence after living donor liver transplantation for patients within the UCSF criteria: re-inventing the role of mammalian target of rapamycin inhibitors
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评估依维莫司在减少 UCSF 标准范围内患者活体肝移植后肝细胞癌复发中的作用：重新发明雷帕霉素抑制剂的哺乳动物靶点的作用
DOI：
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
K. Poon
中科院分区：
文献类型：
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作者：
A. Thorat;L. Jeng;Horng;C. Yeh;S. Hsu;T. Chen;K. Poon
背景/目的依维莫司（EVR）在肝细胞癌（HCC）患者接受肝移植后，在减少复发方面的保护作用尚未在临床试验中得到充分研究。在我们正在进行的研究的第二阶段，我们打算分析EVR作为免疫抑制剂的影响，当它开始于活体肝移植（LDLT）后的早期阶段，在加州大学弗朗西斯科分校（UCSF）标准内的HCC患者的HCC复发。方法2011年1月至2013年6月，我院共收治250例肝细胞癌患者。符合UCSF标准的HCC患者纳入研究，并根据术后免疫抑制分为两组。A组：接受EVR+TAC免疫抑制方案的HCC患者（n=37）。B组：接受标准TAC为基础的免疫抑制方案而不进行EVR的HCC患者（n=29）。EVR的目标谷浓度为3 - 5 ng/ml，而TAC的目标谷浓度为8-10 ng/ml。结果A组患者EVR谷浓度为3.47± 1.53ng/ml（1.5-11.2），剂量为1.00± 0.25mg/d; A组和B组的平均TAC谷浓度分别为6.97±3.98 ng/ml（范围：2.50 - 11.28 ng/ml）和6.93±2.58 ng/ml（范围：2-16.30）。A组患者的1年、3年和4年总生存率分别为94.95%、86.48%和86.48%，而B组患者的1年、3年和4年总生存率分别为82.75%、68.96%和62.06%（p=0.0217）。结论符合UCSF标准的肝移植受者在肝移植术后早期应用EVR可降低肝癌复发率。
Backgrounds/Aims The protective effect of everolimus (EVR) in hepatocellular carcinoma (HCC) patients who receive liver transplantation in terms of reducing the recurrence has not been sufficiently investigated in clinical trials. In this second stage of our ongoing study, we intend to analyze the effects of EVR as an immunosuppressant, when it is started in the early phase after living donor liver transplantation (LDLT), on HCC recurrence in patients with HCC within the University of California at San Francisco (UCSF) criteria. Methods From January 2011 to June 2013, a total of 250 patients underwent LDLT for HCC at our institute. The patients with HCC within the UCSF criteria were included in the study and divided in two groups depending upon the postoperative immunosuppression. Group A: HCC patients that received EVR+TAC based immunosuppressive regimen (n=37). Group B: HCC patients that received standard TAC based immunosuppressive regimen without EVR (n=29). The target trough level for EVR was 3 to 5 ng/ml while for TAC it was 8–10 ng/ml. Results For group A patients, the mean trough level of the EVR was 3.47±1.53 ng/ml (range, 1.5–11.2) with a daily dose of 1.00±0.25 mg/day. For group A and B, the average TAC trough levels were 6.97±3.98 ng/ml (range, 2.50 to 11.28 ng/ml) and 6.93±2.58 (range, 2–16.30), respectively. The 1-year, 3-year and 4-year overall survival achieved for Group A patients was 94.95%, 86.48% and 86.48%, respectively while for Group B patients it was 82.75%, 68.96%, and 62.06%, respectively (p=0.0217). Conclusions EVR use in liver transplant recipients in the early stage after transplantation reduces the HCC recurrence rates in HCC patients within the UCSF criteria.
DOI：
10.1016/s0015-6264(78)80335-6
发表时间：
1986
期刊：
The New Zealand medical journal
影响因子：
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作者：
D. Woodfield
通讯作者：
D. Woodfield