博来霉素经肝动脉化疗栓塞治疗中晚期肝癌的临床观察

Transarterial chemoembolization with bleomycin treatment for moderate-advenced hepatocellular carcinoma

目的评估博来霉素经肝动脉化疗栓塞治疗中晚期肝癌的安全性及有效性。方法前瞻性分析2015年12月至2017年12月解放军总医院经组织病理学或临床诊断确诊的符合巴塞罗那肝癌分期（BCLC）标准的中晚期肝细胞癌患者160例，男135例、女25例，年龄35～74（57±8）岁，均行两次常规肝动脉化疗栓塞术（cTACE）后出现疾病进展，随机分为两组，博来霉素组：博来霉素＋吡柔比星＋奥沙利铂＋氟尿嘧啶；常规治疗组：吡柔比星＋奥沙利铂＋氟尿嘧啶，均再次行肝动脉化疗栓塞术，每4～6周根据mRECIST标准进行疗效评价、生存分析，比较两组总生存时间、无疾病进展时间，并记录不良反应发生情况。结果博来霉素组：肿瘤应答率（CR＋PR）27.5%（22/80），中位无疾病进展时间（mPFS）5.8个月，中位总生存时间（mOS）8.1个月。常规治疗组：肿瘤应答率（CR＋PR）7.5%（6/80），中位无疾病进展时间（mPFS）2.9个月，中位总生存时间（mOS）4个月；两组mOS比较P＝0.009，两组mPFS比较P＝0.002，差异均有统计学意义。两组均无TACE相关严重不良反应。结论博来霉素经肝动脉化疗栓塞治疗中晚期肝癌是安全、有效的。

ObjectiveTo investigate the safety and efficacy of transarterial chemoembolization （TACE） using bleomycin for the treatment of medium-advanced hepatocellular carcinoma （HCC）.MethodsBetween December 2015 and December 2017, a total of 160 patients from the Chinese PLA General Hospital with moderate-advanced HCC whose diagnoses were confirmed by pathology or clinical imaging and were in accord with the Barcelona Clinic Liver Cancer （BCLC） staging criteria were prospectively analyzed.All patients had shown persistent viable tumor or tumor progression after at least 2 sessions of TACE.All patients included 135 males and 25 females , age 35-74 （57±8）years, were randomly divided into two groups, the treatment group： TACE procedures consisted of bleomycin＋ pirarubicin＋ oxaliplatin＋ fluorouracil, the control group： pirarubicin＋ oxaliplatin＋ fluorouracil, and according to modified RECIST criteria the tumor response was evaluated once every 4-6 weeks, survival analysis was performed, overall survival and progression free survival were evaluated.the adverse events were recorded.ResultsResponse rate of the treatment group was 27.5%（22/80）, the median progression free survival（mPFS）was 5.8 months, and the median overall survival （mOS） was 8.1 months.Response rate of the control group was 7.5%（6/80）, mPFS of 2.9 months, and mOS of 4 months.The differences in mPFS and in mOS between the two groups were statistically significant （P=0.009, 0.002 respectively）, and no serious adverse occurred.ConclusionIt is suggested that transarterial chemoembolization with bleomycin is safe and effective for medium-advenced HCC.