TACE联合索拉非尼治疗BCLC-C期肝细胞癌20例疗效分析

Transarterial chemoembolization combined with sorafenib for hepatocellular carcinoma in BCLC-C stage: clinical analysis of 20 cases

目的评价TACE联合索拉非尼治疗BCLC-C期HCC的疗效,为临床选择合理的治疗方案提供依据。方法回顾性分析2008年8月—2014年1月有完整资料的BCLC-C期HCC病例76例,按照不同治疗方法分为3组,其中A组单纯TACE组29例,B组TACE联合索拉非尼组20例,C组支持治疗组27例。观察指标主要为：中位总生存时间（MOS）,中位肿瘤进展时间（MTTP）,疾病控制率（DCR）,3、9和15个月生存率。结果 3组的MOS分别是9.2,12.6和3.1个月（P〈0.01）;MTTP分别为3.2,5.6和1.5个月（P〈0.01）;1～2个月内的DCR分别是82.8%,85.0%和14.8%（P〈0.01）;3个月生存率分别为100%,100%和51.9%（P〈0.01）;9个月生存率分别为51.7%,85%和0（P〈0.01）;15个月生存率分别为10.3%,40%和0（P〈0.01）。但是A组与B组的DCR、3个月生存率相比较,差异无统计学意义（P〉0.05）。结论对于BCLC-C期HCC,TACE联合索拉非尼疗效最优;对于无法联合治疗的患者,单纯TACE优于支持治疗。

Objective To evaluate the efficacy of transarterial chemoembolization（TACE） combined with sorafenib in treating hepatocellular carcinoma（HCC） in Barcelona Clinic Liver Cancer- C stage（BCLCC stage）, and to provide the useful basis for selecting reasonable therapeutic scheme in clinic practice.Methods A total of 76 patients with BCLC- C stage HCC, who were encountered during the period from August 2008 to January 2014 at authors＇ hospital, were enrolled in this study. All patients had complete clinical materials. The clinical data were retrospectively analyzed. According to the therapy adopted, the patients were divided into group A（TACE group, n = 29）, group B（TACE combined with sorafenib, n =20） and group C（supportive treatment, n = 27）. The observation indices included median overall survival time（MOS）, median time to progression（MTTP）, disease control rate（DCR） and 3-, 9- and 15- month survival rate. The results were statistically analyzed. Results MOS of the group A, B and C were 9.2months, 12.6 months and 3.1 months respectively（P〈0.01）. MTTP of the group A, B and C were 3.2months, 5.6 months and 1.5 months respectively（P〈0.01）. DCR within 1- 2 months of the group A, B and C were 82.8%, 85% and 14.8% respectively（P〈0.01）. For group A, B and C the 3-, 9- and 15-month survival rates were 100%, 100% and 51.9%（P〈0.01）, 51.7%, 85% and 0%（P〈0.01） and10.3%, 40% and 0%（P〈0.01）, respectively. No statistically significant differences in DCR and 3- month survival rate existed between group A and group B（P〉 0.05）. Conclusion For the treatment of BCLC- C stage HCC, TACE combined with sorafenib carries the best therapeutic effect. For the patients who cannot endure the combination therapy, simple TACE is superior to supportive treatment.