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Междисциплинарный подход в лечении пациентов с прогрессированием гепатоцеллюлярной карциномы после трансплантации печени: первый опыт в России

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Цель. Улучшение результатов лечения пациентов с прогрессированием гепатоцеллюлярной карциномы после трансплантации печени. Материал и методы. Тридцать пациентов с посттрансплантационным прогрессированием гепатоцеллюлярной карциномы были ретроспективно распределены на две группы. В 1-ю группу включили 20 пациентов, которым оказывали специализированное хирургическое и химиотерапевтическое лечение, во 2-ю - 10 больных, которым в связи с “запущенностью” онкологического заболевания проводили паллиативное и симптоматическое лечение. Результаты. Частота прогрессирования гепатоцеллюлярной карциномы была в 10 раз больше у пациентов, выходящих за пределы Миланских критериев: 57,8 и 5,7% соответственно. Раннее прогрессирование (в течение 24 мес) после трансплантации печени выявлено у 19 (63,3%) пациентов. Медиана общей выживаемости пациентов с ранним и поздним прогрессированием составила соответственно 17 и 74 мес. Полиорганное поражение обнаружено у 40% больных. Однолетняя, трех- и пятилетняя общая выживаемость пациентов 1-й и 2-й групп составила соответственно 90, 71, 50 и 30% и 0%. Медиана общей выживаемости больных 1-й и 2-й групп составила 37,8 и 12 мес. Заключение. Объем опухолевого поражения является определяющим фактором риска прогрессирования гепатоцеллюлярного рака после трансплантации печени. Позднее прогрессирование характеризуется лучшим прогнозом выживаемости. Мультидисциплинарный подход при прогрессировании гепатоцеллюлярной карциномы достоверно улучшает результаты лечения и общую выживаемость.

Ключевые слова:
печень, трансплантация, гепатоцеллюлярная карцинома, сорафениб, прогрессирование, результаты, liver, transplantation, hepatocellular carcinoma, sorafenib, progression, outcome

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Multidisciplinary approach in hepatocellular carcinoma progression treatment after liver transplantation: the first experience in Russia

Aim. To improve treatment outcomes for patients with hepatocellular carcinoma progression after liver transplantation. Material and methods. Patients with hepatocellular carcinoma progression after liver transplantation (n = 30) were divided into two groups retrospectively. Group 1 included 20 patients who underwent specialized surgical and chemotherapeutic treatment, and group 2 included 10 patients who received palliative care in connection with the advanced of the cancer. Results. Tumor progression rate was ten times higher in patients with tumors that do not meet the Milan criteria (57.8% vs 5.7%, respectively). Early progression (within 24 months) after liver transplantation was occured in 19 (63.3%) patients. The median overall survival in patients with early and late progression was 17 and 74 months, respectively. Multiorgan metastases were found in 40% of patients. One-, three- and five-year overall survival in the group 1 and 2 were, respectively, 90%, 71%, 50% and 30% and 0%. The median overall survival in the group 1 and 2 was 37.8 and 12 months respectively. Conclusion. Tumor lesion volume is the determining risk factor for the hepatocellular cancer progression after transplantation. Late disease progression associated with better prognosis. Multidisciplinary approach in treatment of hepatocellular carcinoma progression after liver transplantation significantly improves overall survival.

Keywords:
печень, трансплантация, гепатоцеллюлярная карцинома, сорафениб, прогрессирование, результаты, liver, transplantation, hepatocellular carcinoma, sorafenib, progression, outcome