TACE联合靶向和免疫治疗中晚期肝细胞癌患者疗效研究*

doi:10.3969/j.issn.1672-5069.2025.02.025

摘要/Abstract

摘要： 目的分析经肝动脉化疗栓塞术(TACE)联合靶向和免疫治疗中晚期原发性肝癌(PLC)患者的疗效。方法 2021年4月～2024年9月我院诊治的中晚期PLC患者128例,其中64例接受TACE治疗,另64例接受TACE联合仑伐替尼和信迪利单抗治疗。根据mRECIST评价肿瘤治疗效果,采用ELISA法检测血清α-L-岩藻糖苷酶(AFU)、甲胎蛋白(AFP)、糖类抗原19-9(CA19-9)、肝细胞生长因子(HGF)、血管内皮生长因子(VEGF)、血小板衍生生长因子(PDGF)、碱性成纤维细胞生长因子(bFGF)和半胱氨酸天冬氨酸蛋白酶-4(Caspase-4)和生存素(Survivin)水平。结果考核近期疗效,联合组客观缓解率(ORR)和疾病控制率(DCR)分别为42.2%和79.7%,均显著高于TACE组(分别为23.4%和60.9%,P<0.05);治疗后,联合组血清AFU、AFP和CA19-9水平分别为(183.9±19.7)U/L、(349.7±21.8)ng/mL和(27.8±6.2)KU/L,均显著低于TACE组【分别为(236.2±20.6)U/L、(461.3±24.6)ng/mL和(41.3±6.9)KU/L,P<0.05】;联合组血清HGF、VEGF、PDGF和bFGF水平分别为(71.5±7.9)ng/mL、(303.7±36.4)ng/L、(1507.4±302.4)ng/L和(101.3±14.5)ng/L,均显著低于TACE治疗组【分别为(94.9±8.7)ng/mL、(432.6±41.5)ng/L、(1963.6±314.7)ng/L和(141.5±15.3)ng/L,P<0.05】;联合组血清Caspase-4水平为(44.6±5.8)ng/mL,显著高于TACE组【(37.8±5.5)ng/mL,P<0.05),而血清Survivin水平为(21.1±3.9)ng/mL,显著低于TACE组【(26.1±3.7)ng/mL,P<0.05】。结论采取TACE联合靶向和免疫治疗中晚期PLC患者可收到较好的近期疗效,可能系抑制了肿瘤血管生成,减轻了肿瘤负荷,控制或减缓了疾病进展。

关键词: 原发性肝癌, 肝动脉栓塞化疗, 靶向治疗, 免疫治疗, 治疗

Abstract: Objective The aim of this study was to investigate the efficacy of transcatheter arterial chemoembolization (TACE) and targeted immunotherapy combination in treatment of patients with advanced primary liver cancer (aPLC). Methods A total of 128 patients with aPLC were enrolled in our hospital between April 2021 and September 2024, and were randomly assigned to receive TACE in 64 cases, or receive TACE plus lenvatinib and sintilimab monoclonal antibody combination therapy in another 64 cases. Short-term efficacy was evaluated according to mRECIST. Serum α-L-fucosidase (AFU), alpha-fetoprotein (AFP), carbohydrate antigen 19-9 (CA19-9), hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF), cysteine aspartic protease-4 (Caspase-4) and survivin levels were detected by ELISA. Results Objective remission rate (ORR) and disease control rate (DCR) in combination treatment group were 42.2% and 79.7%, both significantly higher than 23.4% and 60.9% in TACE-treated group (P<0.05); after treatment, serum AFU,AFP and CA19-9 levels in combination-treated patients were (183.9±19.7)U/L, (349.7±21.8)ng/mL and (27.8±6.2)KU/L, all significantly lower than [(236.2±20.6)U/L, (461.3±24.6)ng/mL and (41.3±6.9)KU/L, respectively, P<0.05] in TACE alone-treated patients; serum HGF, VEGF, PDGFand bFGF levels were (71.5±7.9)ng/mL, (303.7±36.4)ng/L, (1507.4±302.4)ng/L and (101.3±14.5)ng/L, all much lower than [(94.9±8.7)ng/mL, (432.6±41.5)ng/L, (1963.6±314.7)ng/Land (141.5±15.3)ng/L, respectively, P<0.05] in the control; serum Caspase-4 level was (44.6±5.8)ng/mL, much higher than [(37.8±5.5)ng/mL, P<0.05), while serum survivin level was (21.1±3.9)ng/mL, much lower than [(26.1±3.7)ng/mL, P<0.05]in TACE alone-treated patients. Conclusion TACE plus targeted immunotherapy is an promising approach for management of patients with aPLC, which might relieve tumor burden and control the disease progression.

Key words: Hepatoma, Transcatheter arterial chemoembolization, Targeted therapy, Immunotherapy, Therapy

陈思雨, 庞永平, 宋云鹏, 乔海霞. TACE联合靶向和免疫治疗中晚期肝细胞癌患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(2): 258-261.

Chen Siyu, Pang Yongping, Song Yunpeng, et al. Efficacy of TACE plus targeted immunotherapy in patients with advanced primary liver cancer[J]. Journal of Practical Hepatology, 2025, 28(2): 258-261.

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TACE联合靶向和免疫治疗中晚期肝细胞癌患者疗效研究^*

Efficacy of TACE plus targeted immunotherapy in patients with advanced primary liver cancer

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