摘要
目的探讨阿帕替尼联合经肝动脉化疗栓塞术(TACE)治疗巴塞罗那临床肝癌分期系统(BCLC)B/C期肝癌的安全性及有效性。方法采用回顾性研究方法收集自2017年8月至2019年8月在湖北医药学院附属医院就诊的BCLC分期为B期或C期肝癌病人的临床资料进行研究,经过筛选后最终有58例病人纳入研究,根据治疗方法不同分为暴露组(阿帕替尼联合TACE治疗,29例)和非暴露组(TACE治疗,29例),所有病人至少随访12个月,比较两组病人的疾病控制率、生存率、实验室指标等变化以及不良反应发生率。结果暴露组和非暴露组:完全缓解(CR)分别为1例和0,部分缓解(PR)分别为18例和13例,稳定(SD)分别为6例和4例,进展(PD)分别为4例和12例;暴露组和非暴露组的客观有效率(ORR)分别为65.5%和44.8%,差异有统计学意义(P<0.05);暴露组和非暴露组的疾病控制率(DCR)分别为86.2%和58.6%,差异也有统计学意义(P<0.05)。两组病人3个月的生存率差异无统计学意义,6个月生存率分别为82.8%和55.2%,差异有统计学意义(P<0.05);12个月的生存率分别为58.6%和37.9%,差异有统计学意义(P<0.05)。通过绘制Kaplan-Meier生存曲线,发现暴露组和非暴露组病人的中位总生存时间(mOS)分别为12.2个月[95%CI(11.633,12.687)]和6.1个月[95%CI(4.213,8.187)],两组病人的生存时间存在差异(P<0.05)。两组病人治疗3个月后分别与同组治疗前相比甲胎蛋白水平较治疗前明显下降,差异有统计学意义(P<0.05);两组病人治疗3个月后,暴露组甲胎蛋白水平比非暴露组下降更明显,差异有统计学意义(P<0.05)。暴露组者发生高血压、手足综合征、出血的发生率明显高于非暴露组,且差异有统计学意义(P<0.05);而乏力、腹泻等不良反应的差异无统计学意义(P>0.05)。结论甲磺酸阿帕替尼联合TACE治疗中晚期肝癌的疗效优于单独使用TACE治疗,而阿帕替尼带来的不良反应可以耐受。
Objective To evaluate the safety and efficacy of apatinib combined with transcatheter arterial chemoembolization(TACE)in the treatment of BCLC stage B/C liver cancer.Methods Patients with BCLC stage B or C liver cancer were enrolled in our hospital from August 2017 to August 2019.After screening,58 patients were divided into exposure group(apatinib combined with TACE treatment)and non-exposure group(TACE treatment).All patients were followed up for at least 12 months.The disease control rate,survival rate,laboratory indexes and the incidence of adverse reactions were compared between the two groups.Results Exposure group and non-exposure group:complete response(CR)was 1 and 0,partial response(PR)was 18 and 13,stable diseases(SD)was 6 and 4,and progressive diseases(PD)was 4 and 12,respectively.The objective response rate(ORR)of exposure group and non-exposure group was 65.5%and 44.8%,respectively.The disease control rate(DCR)of exposure group and non-exposure group was 86.2%and 58.6%respectively,and the difference was also statistically significant(P<0.05).There was no difference in the 3-month survival rate between the two groups,the 6-month survival rate was 82.8%and 55.2%respectively(P<0.05),and the 12-month survival rate was 58.6%and 37.9%respectively(P<0.05).By plotting the Kaplan-Meier survival curve,it was found that the median overall survival time(mOS)in the exposed group and the non-exposed group was 12.2[95%CI(11.633,12.687)]and 6.1[95%CI(4.213,8.187)]months,respectively.There was significant difference in survival time between the two groups(P<0.05).After 3 months of treatment,the level of alpha-fetoprotein(AFP)in the two groups was significantly lower than that before treatment(P<0.05),and the level of AFP in the exposure group was significantly lower than that in the non-exposure group,the difference was statistically significant(P<0.05).The incidence of hypertension,hand-foot syndrome and bleeding in the exposure group was significantly higher than that in the non-exposure group(P<0.05),and the difference was statistically significant,while there was no significant difference in fatigue,diarrhea and other adverse reactions(P>0.05).Conclusion The efficacy of apatinib mesylate combined with TACE in the treatment of advanced hepatocellular carcinoma is better than that of TACE alone,and the adverse reactions caused by apatinib can be tolerated.
作者
张恒
江斌
王健
孟忠吉
王琼
Zhang Heng;Jiang Bin;Wang Jian;Meng Zhongji;Wang Qiong(Department of Hepatobiliary and Pancreatic Surgery,Taihe Hospital,Hubei University of Medicine,Hubei Shiyan 442000,China;Department of Infectious Disease,Taihe Hospital,Hubei University of Medicine,Hubei Shiyan 442000,China)
出处
《腹部外科》
2021年第2期138-143,共6页
Journal of Abdominal Surgery
基金
湖北陈孝平科技发展基金会基金(CXPJJH11800001-2018246)。
关键词
阿帕替尼
经导管肝动脉化疗栓塞
肝细胞癌
疗效
不良反应
Apatinib
Transcatheter arterial chemoembolization
Hepatocellular carcinoma
Efficacy
Adverse reactions
