卡瑞利珠单克隆抗体联合阿帕替尼治疗中晚期肝细胞癌患者疗效及预后分析*

doi:10.3969/j.issn.1672-5069.2024.01.025

摘要/Abstract

摘要： 目的探讨应用卡瑞利珠单克隆抗体联合阿帕替尼治疗中晚期肝细胞癌(HCC)患者的疗效及其影响预后的因素。方法 2019年6月～2021年10月新疆医科大学第一附属医院收治的中晚期HCC患者117例,其中联合治疗组65例接受卡瑞利珠单克隆抗体联合阿帕替尼治疗,另52例接受阿帕替尼治疗。根据mRECIST评价肿瘤治疗效果,采用Kaplan-Meier法分析无进展生存期(PFS)及其影响因素,应用多因素COX回归分析影响PFS的因素。结果随访12月,联合治疗组客观缓解率(ORR)和疾病控制率(DCR)分别为44.7%和66.2%,显著高于阿帕替尼治疗组的15.4%和42.3%(P<0.05);在治疗3个月末,联合治疗组血小板(PLT)计数为81.0(51.5,145.5)×10⁹/L,显著低于单药治疗组[107.0(69.5,191.0)×10⁹/L,P<0.05];联合治疗组PFS为10.6(95%CI:9.986～11.16)个月,显著长于阿帕替尼组的7.9(95%CI:6.84～8.944)个月(Log-rank=12.807,P<0.05);体力活动状态(PS)、Child-Pugh评分、CNLC分期、有无肝硬化、门脉癌栓和肝动脉化疗栓塞术(TACE)是影响PFS的因素(P<0.05);COX多因素回归分析显示,Child-Pugh B级(HR=2.379,P=0.021)和伴有门脉癌栓(HR=3.481,P=0.003)是影响中晚期HCC患者PFS的独立危险因素,而TACE(HR=0.528,P=0.034)则是独立保护因素。结论应用卡瑞利珠单克隆抗体联合阿帕替尼治疗中晚期HCC患者能有效提高疗效,延长生存时间。对于肿瘤负荷较大的患者,加用TACE联合治疗可以帮助临床获益。

关键词: 肝细胞癌, 卡瑞利珠单克隆抗体, 阿帕替尼, 治疗, 晚期

Abstract: Objective This clinical trial was conducted to investigate the efficacy of camrelizumab and apatinib combination in the treatment of patients with advanced hepatocellular carcinoma (HCC). Methods A total of 117 patients with advanced HCC were admitted to the first affiliated Hospital of Xinjiang Medical University between June 2019 and October 2021, and 65 patients were treated with camrelizumab and apatinib combination, and 52 patients were treated by apatinib alone. All patients were followed-up for one year. The therapeutic efficacy was evaluated according to mRECIST, the progression-free survival (PFS) and its influencing factors were analyzed by Kaplan-Meier method, and the prognostic factors of PFS were analyzed by multivariate COX regression. Results The objective remission rate (ORR) and the disease control rate (DCR) in patients with combination treatment were 44.7% and 66.2%, both significantly greater than 15.4% and 42.3% in the apatinib-treated patients (P<0.05); at the end of three-month treatment, the blood platelet count in patients with combination treatment was 81.0(51.5, 145.5)×10⁹/L, much lower than [107.0(69.5, 191.0)×10⁹/L P<0.05] in patients with apatinib treatment alone; the PFS in patients with combination treatment was 10.6 (95%CI:9.986-11.16) months, significantly longer than 7.9 (95%CI:6.84-8.944) months in the apatinib-treated group (Log-rank=12.807,P<0.05); the performance status (PS), Child-Pugh score, CNLC stage, liver cirrhosis, portal vein tumor thrombus and transarterial chemoembolization (TACE) were the prognostic factors impacting PFS, and the multivariate COX regression analysis showed that the Child-Pugh grade B (HR=2.379,P=0.021) and portal vein tumor thrombus (HR=3.481,P=0.003) were the independent risk factors for PFS, while the TACE (HR=0.528, P=0.034) was an independent protective factor for PFS in patients with advanced HCC. Conclusion The combination of camrelizumab and apatinib in treating patients with advanced HCC could effectively improve the clinical efficacy, with an obvious prolonged survival period. For patients with high tumor load, the auxiliary TACE might help raise better clinical benefits.

Key words: Hepatocellular carcinoma, Camrelizumab, Apatinib, Therapy, Advanced

叶萌萌, 邓泽润, 张韬. 卡瑞利珠单克隆抗体联合阿帕替尼治疗中晚期肝细胞癌患者疗效及预后分析^*[J]. 实用肝脏病杂志, 2024, 27(1): 96-100.

Ye Mengmeng, Deng Zerun, Zhang Tao. Improved benefit of camrelizumab and apatinib combination in the treatment of patients with advanced hepatocellular carcinoma[J]. Journal of Practical Hepatology, 2024, 27(1): 96-100.

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卡瑞利珠单克隆抗体联合阿帕替尼治疗中晚期肝细胞癌患者疗效及预后分析^*

Improved benefit of camrelizumab and apatinib combination in the treatment of patients with advanced hepatocellular carcinoma

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