甲胎蛋白应答在索拉菲尼治疗进展期肝癌中的作用

Effect of alpha-fetoprotein response for treatment of advanced hepatocellular carcinoma patients with sorafenib

目的探讨甲胎蛋白（AFP）在索拉菲尼治疗进展期肝细胞肝癌中的作用和临床意义,以及索拉菲尼临床毒副作用。方法回顾性分析2009年8月至2012年8月应用索拉菲尼治疗的45例无法手术切除的原发性肝细胞癌病例临床资料。将其分为AFP应答组和无应答组,分析其与临床预后的关系。按照癌症研究所常见毒性反应标准对药物不良反应进行评价和分级。结果本组患者随访2~24个月。AFP应答组患者疾病控制率（CR＋PR＋SD）为61.1%;AFP无应答组疾病控制率为51.8%。AFP应答组和无应答组中位总生存期分别为13.5个月和8个月。多因素分析显示,AFP应答、肝炎、TNM分期及静脉侵袭是影响肝癌患者总生存期的独立危险因素。常见药物毒性反应为手足皮肤反应、相关胃肠道反应（包括恶心、呕吐、腹泻、口腔黏膜炎）和脱发。结论索托菲尼治疗晚期原发性肝细胞癌,在AFP应答组效果较好,用药前肝炎情况、TNM分期及静脉侵袭可能对预测索托菲尼的疗效有帮助。

ObjectiveTo investigate the usefulness of AFP response in sorafenib therapy patients with advanced hepatocellular carcinoma. MethodsForty-five patients who received sorafenib therapy with unresectable or metastatic HCC were included in this study from Aug 2008 to Aug 2012. Patients were set up into two groups according to the response of AFP. The relationship between different clinical variable factors and curative effects of sorafenib was analyzed by using Cox proportion hazard regression analysis and the side effects were also estimated. ResultsOf these cases, Fifteen patients in the AFP response group had tumor progression and 14 died, the disease control rate was 61.1%,while 21 patients in the AFP non-response group had tumor progression and 18 died,.the disease control rate was 51.8%. The median time to overall survival time was 13.5 months and 8 months（P〈0.05） in AFP response group and AFP non-response group, respectively. Multivariate analysis showed that AFP response,cirrhosis,TNM stage and venous invasion were independent predictors of shorter overall survival time. Hand-foot syndrome, related gastrointestinal tract reaction and alopecia were the first three side effect events. ConclusionAFP response may be considered as an alternative marker for capture sorafenib activity in HCC. Cirrhosis, TNM stage and venous invasion maybe consider as another possible predict factor to sorafenib in advanced HCC patients.