TACE术后阿帕替尼维持治疗进展期肝细胞癌患者疗效分析*

doi:10.3969/j.issn.1672-5069.2021.05.032

摘要/Abstract

摘要： 目的研究经导管肝动脉化疗栓塞术(TACE)后应用阿帕替尼维持治疗进展期肝细胞癌(HCC)患者的疗效及其影响因素。方法 2018年1月～2019年12月我院收治的138例进展期HCC患者,采用TACE治疗后给予阿帕替尼维持治疗2～3个疗程。采用化学发光免疫分析法检测血清甲胎蛋白(AFP)水平,采用ELISA法检测血浆热休克蛋白90α(HSP90α)水平。应用多因素Logistic回归分析影响治疗疗效的危险因素。结果在治疗结束时,138例患者获得CR 10例(7.2%),PR 56例(40.6%),SD 42例(30.4%),PD 30例(21.7%);单因素分析发现,疾病进展组年龄≥60岁、Child-Pugh B级、BCLC C期、肿瘤直径≥5 cm、AFP≥400.0 U/L和HSP90α≥460.0 ng/mL占比分别为57.4%、55.2%、53.2%、55.3%、62.5%和65.7%,显著高于疾病控制组的42.6%、44.8%、46.8%、44.7%、37.5%和34.3%(P＜0.05);多因素Logistic回归分析显示,Child-Pugh分级、BCLC分期、血清AFP和HSP90α水平是进展期HCC患者接受TACE治疗后阿帕替尼维持治疗临床疗效的独立影响因素(P＜0.05)。结论在TACE术后应用阿帕替尼维持治疗进展期HCC患者有一定的近期疗效,但临床医生应该了解影响疗效的因素,选择合适的患者治疗,以期让患者最大程度地获益。

关键词: 肝细胞癌, 经导管肝动脉化疗栓塞术, 阿帕替尼, 热休克蛋白90α, 治疗, 影响因素

Abstract: Objective This study aimed to investigate the impacting efficacy factors of apatinib maintaining treatment after transcatheter hepatic artery chemoembolization (TACE) in patients with advanced hepatocellular carcinoma (HCC). Methods 138 patients with advanced HCC were recruited in our hospital between January 2018 and December 2019, and all patients received apatinib maintenance therapy after TACE for 2 to 3 courses of treatment. Serum alpha fetoprotein (AFP) level was detected by chemiluminescence immunoassay and plasma level of heat shock protein 90 α (Hsp90 α) was measured by ELISA. The impacting efficacy factors were analyzed by multivariate Logistic regression analysis. Results At the end of the treatment, 10 patients (7.2%) obtained complete response, 56 patients (40.6%) obtained partial response, 42 patients (30.4%) got stable disease, and 30 patients (21.7%) got progressive disease; the proportions of age older than 60 years, Child-Pugh class B, BCLC stage C, tumor diameter greater than 5 cm, serum AFP level greater than 400.0 U/L and HSP90 level greater than 460.0 ng/mL in patients with progressive disease were 57.4%, 55.2%, 53.2%, 55.3%, 62.5% and 65.7%, allsignificantly higher than 42.6%, 44.8%, 46.8%, 44.7%, 37.5% and 34.3% in the disease controlled group (P<0.05); the multivariate Logistic regression analysis showed that Child-Pugh classification, BCLC stage, serum AFP and HSP90 were the independent factors influencing the clinical efficacy of apatinib after TACE in patients with advanced HCC (P<0.05). Conclusion The apatinib maintenance therapy after TACE in the treatment of patients with advanced HCC has to some extent short-term efficacy, however, the clinicians should take some influencing efficacy factors into consideration, and select the eligible patients for treatment.

Key words: Hepatocellular carcinoma, Transcatheter arterial chemoembolization, Apatinib, Heat shock protein 90α, Efficacy, Impacting factors

张英, 张雷, 丁海涛. TACE术后阿帕替尼维持治疗进展期肝细胞癌患者疗效分析^*[J]. 实用肝脏病杂志, 2021, 24(5): 733-736.

Zhang Ying, Zhang Lei, Ding Haitao. Impacting efficacy factors of apatinib maintaining treatment after transcatheter hepatic artery chemoembolization in patients with advanced hepatocellular carcinoma[J]. Journal of Practical Hepatology, 2021, 24(5): 733-736.

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TACE术后阿帕替尼维持治疗进展期肝细胞癌患者疗效分析^*

Impacting efficacy factors of apatinib maintaining treatment after transcatheter hepatic artery chemoembolization in patients with advanced hepatocellular carcinoma

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