沙利度胺联合TACE术治疗中晚期肝癌的临床观察

Combination of thalidomide and transcatheter arterial chemoembolization for advanced hepatocellular carcinoma

目的:探讨沙利度胺联合肝动脉化疗栓塞术(TACE)对无法手术切除的中晚期肝癌的疗效以及血管内皮生长因子(VEGF)在TACE术前及术后的变化。方法:收集2004-12-01-2007-12-31入住徐州市肿瘤医院无法手术切除的100例中晚期肝癌患者,随机分为治疗组(沙利度胺+TACE术,50例)和对照组(单纯TACE术,50例)。治疗组患者每晚口服200 mg沙利度胺,服用至少3个月,所有患者至少行TACE术2次,并检测TACE术前1周及术后2周血清VEGF水平。结果:治疗组和对照组有效率分别为56.0%和42.0%,两组间差异无统计学意义,P>0.05;治疗组和对照组疾病控制率(DCR)分别为80.0%和56.0%,两组比较差异有统计学意义,P<0.05;治疗组和对照组1年生存率分别为64.0%和62.0%,2年生存率分别为28.0%和24.0%,差异均无统计学意义,P>0.05;血清VEGF水平治疗组治疗后下降显著,P<0.05;对照组治疗后较治疗前血清VEGF水平偏高,对比差异无统计学意义,P>0.05。结论:沙利度胺联合TACE术能改善中晚期肝癌患者的疾病控制率,并降低血清VEGF水平,有可能延长患者生存及有效率。

OBJECTIVE： To evaluate the response rate, DCR, 1- and 2-year survival rate in patients with advanced hepatocellular carcinoma, who were treated with thalidomide plus TACE or TACE alone and to compare the levels of serum VEGF of the patients before and after the treatment; METHODS： From December 1,2004 to December 31,2007, 100 patients with advanced hepatocellular carcinoma were randomized in- to combination （TACE plus thalidomide） group and TACE group. Com- bination group received oral administration of thalidomide （200 mg/d） for at least 3 months. Both groups underwent TACE at least twice. Before and after the treatment, the enzyme linked immunosorbentassay （ELISA） was used to examine the change of VEGF. RESULTS： Of 100 assessable patients, overall response rate was 56.0% in combined group and 42.0% in TACE group respectively （P）0. 05）. The disease con- trol rate was 80.0% in combined group and 56.0~ in TACE group （P^0. 05）. The 1- and 2-year survival rates were 64. 0%, 28. 0% respectively in combined group and 62.0%, 24. 0% respectively in TACE group （P〈0.05）. The levels of serum VEGF in combined group were significantly decreased after treatment in effective cases （P〈 0. 05）. There was no significant difference between the levels of serum VEGF before and after treatment in TACE group （P〈0.05）. CONCLUSIONS： The combination of thalidomide and TACE results in a more effective disease control rate than in TACE alone group with advanced hepatocellular carcinoma. Thalidomide plus TACE can cut down the levels of serum VEGF in patients with advanced hepatocellular carcinoma. Thalidomide plus TACE can probably prolong the survival and the overall response rate of advanced hepatocellular carcinoma.