经肝动脉化疗栓塞联合索拉非尼治疗巨大肝癌的临床疗效及安全性观察

The clinical efficacy and safety of transcatheter arterial chemoembolization combined with sorafenib in the treatment of large hepatocellular carcinoma

目的：探讨经肝动脉化疗栓塞（TACE）联合索拉非尼治疗巨大肝癌的临床疗效及安全性。方法：回顾性分析2009年6月-2013年6月我院收治的85例巨大肝癌（直径≥10cm）患者的临床资料。其中采用TACE联合索拉非尼治疗的患者共26例作为观察组,单纯采用TACE治疗的患者共37例作为对照组1,单纯采用索拉非尼治疗的患者共22例作为对照组2。Kaplan-Meier法绘制三组患者的生存曲线,采用Log-rank比较三组的中位生存期、生存率、中位肿瘤进展时间,观察并对比三组的不良反应发生率。结果：观察组、对照组1、对照组2中位生存期分别为16.3个月（95%CI：10.1~22.3个月）、10.4个月（95%CI：7.2~13.5个月）、6.2个月（95%CI：4.2~5.6个月）,差异具有统计学意义（P〈0.05）;观察组1年、2年、3年生存率明显高于其他两组,差异具有统计学意义（P〈0.05）;观察组、对照组1、对照组2的中位肿瘤进展时间分别为6.5个月（95%CI：3.2~10.4个月）、3.2个月（95%CI：1.6~5.5个月）、2.3个月（95%CI：1.2~3.4个月）,差异具有统计学意义（P〈0.05）。三组的不良反应发生率比较差异无统计学意义（P〉0.05）。结论：TACE联合索拉非尼治疗巨大肝癌可以延缓肿瘤进展,延长生存期,安全性和耐受性良好,具有良好的临床应用前景。

Objective：To study the clinical efficacy and safety of transcatheter arterial chemoembolization combined sorafenib in the treatment of large hepatocellular carcinoma.Methods：Retrospectively analyse the clinical data of 85 cases of patients with large hepatocellular carcinoma（ diameter≥10cm） from June 2009-June 2013,including26 patients received transcatheter arterial chemoembolization combined with sorafenib therapy as observation group,37 patients received the transcatheter arterial chemoembolization therapy as control group 1,22 patients received the sorafenib therapy as control group 2.Kaplan-Meier method was used to draw the survival curves.The median survival time,survival rate,the median tumor progress time of the three groups using the Log-rank test were compared and the incidence of adverse reactions of the three groups were observed.Results：The median survival time of the observation group,control group 1 and group 2 respectively was 16.3 months（ 95% CI：10.1 ~ 22.3 months）,10.4 months（ 95% CI：7.2 ~ 13.5 months）,and 6.2 months（ 95% CI：4.2 ~ 5.6 months）（ P〈0.05）.1,2,3 year survival rates of the observation group were significantly higher than the other two groups,which had statistically significant difference（ P〈0.05）.The median tumor progress time of the observation group,control group 1 and group 2 respectively was6.5 months（ 95% CI：3.2 ~ 10.4 months）,and 3.2 months（ 95% CI：1.6 ~ 5.5 months）,2.3 months（ 95% CI：1.2 ~3.4 months）,which had statistically significant difference（ P〈0.05）.The incidences of adverse reactions of the three group had no statistically significant difference（ P〉0.05）.Conclusion：Transcatheter arterial chemoembolization combined with sorafenib in treatment of large hepatocellular carcinoma can delay the tumor progression,prolong the survival period,and have the well safety tolerance,which has a good prospect of clinical application.