TACE序贯微波消融联合索拉非尼治疗大肝细胞癌患者临床疗效研究

doi:10.3969/j.issn.1672-5069.2023.01.028

摘要/Abstract

摘要： 目的探讨采取经肝动脉化疗栓塞(TACE)序贯微波消融(MWA)联合索拉非尼治疗大体积肝细胞癌(HCC)患者临床效果。方法 2017年4月～2019年4月我院诊治的大体积HCC患者144例,其中联合组74例接受TACE序贯MWA联合索拉非尼治疗,另70例接受TACE和索拉非尼治疗,随访2年。结果在治疗后3 m,联合组肿瘤客观缓解率和疾病控制率分别为73.0%和98.6%,显著高于TACE组的47.1%和88.6%(P＜0.05);联合组血清AFP水平为(128.0±14.4)μg/L,显著低于TACE组[(208.7±27.3)μg/L,P＜0.05],KPS评分为(88.7±8.2)分,显著高于TACE组[(79.4±7.9)分,P＜0.05];联合组并发症发生率为39.2%,与TACE组的34.3%比,无显著性差异(P＞0.05);联合组腹泻、食欲下降、脱发、恶心和呕吐和皮肤反应等不良反应发生率分别为24.3%、27.0%、20.3%、13.5%和18.9%,与TACE组的24.3%、30.0%、24.3%、17.1%和18.6%比,无显著性差异(P＞0.05);在随访2年末,联合组失访5例,TACE组失访2例。联合组1 a生存率为97.1%(67/69),2 a生存率为73.9%(51/69),TACE组分别为79.4%(54/68)和52.9%(36/68),经Kaplan-Meier生存分析显示联合组生存率显著高于TACE组(Log-Rank=11.857,P=0.001)。结论采用TACE序贯MWA联合索拉非尼治疗大体积HCC患者有效,能够改善患者预后,值得探索。

关键词: 原发性肝癌, 经肝动脉化疗栓塞, 微波消融, 索拉非尼, 治疗

Abstract: Objective The purpose of this study was to investigate the clinical efficacy of transhepatic arterial chemoembolization (TACE) with sequential microwave ablation (MWA) followed by oral sorafenib maintenance in treatment of patients with large hepatocellular carcinoma (HCC). Methods A total of 144 patients with large HCC were encountered in our hospital between April 2017 and April 2019, and 74 patients were treated by TACE with sequential MWA followed by oral sorafenib maintenance and another 70 patients received TACE and oral sorafenib. All patients were followed-up for two years. Results At the end of three month, the objective remission rate and disease control rate in the combination group were 73.0% and 98.6%, both significantly higher than 47.1% and 88.6%(P＜0.05) in TACE-treated patients; serum AFP level was (128.0±14.4)μg/L, significantly lower than [(208.7±27.3)μg/L, P＜0.05], and KPS's score was (88.7±8.2), significantly higher than [(79.4±7.9), P＜0.05] in TACE-treated patients; the incidence of post-operational complications was 39.2%, not significantly different compared to 34.3% in TACE-treated patients (P＞0.05); the incidence of diarrhea, anorexia, alopecia, nausea and vomiting, and skin reactions were 24.3%, 27.0%, 20.3%, 13.5% and 18.9%, not significantly different compared to 24.3%, 30.0%, 24.3%, 17.1% and 18.6% in TACE-treated patients (P＞0.05); at the end of two-year followed-up, 5 cases and 2 cases were lost in the two groups respectively, and the one-year survival rate in the combination group was 97.1%(67/69) and the two-year survival rate was 73.9%(51/69), both significantly higher than 79.4%(54/68) and 52.9%(36/68) in TACE-treated patients (Log-Rank=11.857, P=0.001). Conclusion The strategy of TACE with sequential MWA and oral sorafenib maintenance in treating patients with large-volume HCC is encouraging, which warrants further clinical investigation.

Key words: Hepatoma, Transhepatic arterial chemoembolization, Microwave ablation, Sorafenib, Therapy

丁海斌, 张欣, 李雅, 聂磊, 常柏玲, 王颖栋. TACE序贯微波消融联合索拉非尼治疗大肝细胞癌患者临床疗效研究[J]. 实用肝脏病杂志, 2023, 26(1): 108-111.

Ding Haibin, Zhang Xin, Li Ya, et al. TACE with sequential microwave ablation followed by oral sorafenib maintenance in treatment of patients with large hepatocellular carcinoma[J]. Journal of Practical Hepatology, 2023, 26(1): 108-111.

参考文献

[1] Lee T, Park CK, Ha SY . Prognostic role of apelin receptor expression in hepatocellular carcinoma treated with curative surgical resection. Anticancer Res, 2019, 39(6):3025-3031.
[2] Girometti R, Pin MD, Pullini S, et al. Accuracy of visual analysis vs. Apparent diffusion coefficient quantification in differentiating solid benign and malignant focal liver lesions with diffusion-weighted imaging. Laradiol Med, 2013, 118(3):343-355.
[3] 胡韵清, 顾思萌, 叶丁,等. 慢性乙型肝炎发生HCC风险预测模型的研究进展. 中华传染病杂志, 2018, 36(3):185-188.
[4] Akinyemiju T, Abera S, Ahmed MM, et al. The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level: Results from the global burden of disease study 2015. JAMA Oncol, 2017, 3(12):1683-1691.
[5] Perfahl H, Jain HV, Joshi T, et al. Hybrid modelling of transarterial chemoembolisation therapies (TACE) for hepatocellular carcinoma (HCC). Sci Rep, 2020, 10(1):10571-10571.
[6] Zhou Q, Wu S, Gong NQ, et al. Liposomes loading sodium chloride as effective thermo-seeds for microwave ablation of hepatocellular carcinoma. Nanoscale, 2017, 9(31):11068-11076.
[7] Marrero JA, Lulik LM, Sirlin CB, et al. Diagnosis, staging and management of hepatocellular carcinoma: 2018 practice guidance by the American association for the study of liver diseases. Hepatology, 2018, 68(2):723-750.
[8] Galle PR, Forner A, Llovet JM, et al. Easl clinical practice guidelines: Management of hepatocellular carcinoma. J Hepatol, 2018, 69(1):182-236.
[9] 閤谦, 吴骋, 童林军,等. RECIST 1.1,PERCIST1.0,WHO及EORTC用于评价结直肠癌肝脏转移化疗后疗效的比较. 中华核医学与分子影像杂志, 2017, 37(9):559-563.
[10] Chernov MF, Nakaya K, Izawa M, et al. Outcome after radiosurgery for brain metastases in patients with low Karnofsky performance scale (KPS) scores. Int J Radiat Oncol Biol Phys, 2007, 67(5):1492-1498.
[11] Nakamura M, Fukumitsu N, Kamizawa S, et al. A validated proton beam therapy patch-field protocol for effective treatment of large hepatocellular carcinoma. J Radiat Res, 2018, 59(5):632-638.
[12] Fang F, Xie QS, Chen JM, et al. Long-term outcomes after hepatectomy of huge hepatocellular carcinoma: A single-center experience in china. Hepatobiliary Pancreat Dis Int, 2019, 18(6):40-45.
[13] Lencioni R, Baere TD, Soulen MC, et al. Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data. Hepatology, 2016, 64(1):106-116.
[14] Filippiadis DK, Spiliopoulos S, Konstantos C, et al. Computed tomography-guided percutaneous microwave ablation of hepatocellular carcinoma in challenging locations: Safety and efficacy of high-power microwave platforms. Int J Hyperthermia, 2018, 34(6):863-869.
[15] Kudo M, Finn RS, Qin S, et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: A randomised phase 3 non-inferiority trial. Lancet, 2018, 391(10126):1163-1173.
[16] Budhu A, Forgues M, Ye QH, et al. Prediction of venous metastases, recurrence, and prognosis in hepatocellular carcinoma based on a unique immune response signature of the liver microenvironment. Cancer Cell, 2006, 10(2):99-111.
[17] Xu LF, Sun HL, Chen YT, et al. Large primary hepatocellular carcinoma: Transarterial chemoembolization monotherapy versus combined transarterial chemoembolization-percutaneous microwave coagulation therapy. J Gastroenterol Hepatol, 2013,2013, 28(3):456-463.
[18] 朱忠杰, 王喜功, 李雷,等. 经导管动脉内化疗栓塞术联合索拉非尼序贯微波消融和经导管动脉内化疗栓塞术联合索拉非尼治疗肿瘤直径>5 cm HCC的前瞻性研究. 中华消化外科杂志, 2020, 19(2):145-155.
[19] 陈俊伟, 赖丽莎, 罗骏阳,等. TACE联合射频消融及索拉非尼治疗巨块型HCC的回顾性研究. 中华肝胆外科杂志, 2021, 27(1):47-51.