三维适形放疗联合阿帕替尼治疗晚期原发性肝细胞癌的疗效

Effects of Three-Dimensional Conformal Radiotherapy Combined with Apatinib in the Treatment of Advanced Hepatocellular Carcinoma

目的探讨三维适形放疗(3D-CRT)联合阿帕替尼治疗晚期原发性肝细胞癌(AHCC)的疗效。方法选取2015年3月-2016年6月我院收治的86例AHCC患者为研究对象,采用随机数字表法分为对照组和观察组,各43例。对照组患者接受3D-CRT治疗,观察组患者在3D-CRT基础上予以阿帕替尼。治疗后3个月行增强CT检查,比较两组患者治疗效果及不良反应,检测治疗前后血清甲胎蛋白(AFP)、血管内皮细胞生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)、总胆红素(TBIL)的水平。随访2年,记录6个月、1年和2年的生存率。结果治疗后3个月,观察组患者疾病控制率(67.4%)显著高于对照组(48.8%)(P<0.05)。两组患者血清AFP、VEGF和bFGF水平均明显下降(P<0.05),且观察组显著低于对照组(P<0.05);治疗后观察组TBIL较治疗前明显升高,且显著高于对照组(P<0.05)。观察组患者高血压、蛋白尿发生率高于对照组(P<0.05);两组恶心呕吐、骨髓抑制、转氨酶升高、凝血功能异常、手足综合征的发生率比较,差异无统计学意义(P>0.05);两组均未出现心脏毒性。观察组1年和2年生存率分别为55.8%和34.9%,均高于对照组的32.6%和13.9%,差异有统计学意义(P<0.05)。结论 3D-CRT联合阿帕替尼治疗AHCC的疗效较好,可明显提高患者远期生存率,且不良反应可耐受,安全性较高,可能与抑制肿瘤新生血管生成有关。

Objective To investigate the effects of three-dimensional conformal radiotherapy(3 D-CRT) combined with apatinib in the treatment of advanced hepatocellular carcinoma(AHCC). Methods A total of 86 patients with AHCC admitted to the Department of Oncology of Wuxi No.2 People’s Hospital between March 2015 and June 2016 were selected as subjects. All of the patients were randomly divided into control group and observation group, 43 cases in each group. Patients in control group were treated with 3 D-CRT, while patients in observation group were treated with apatinib on the basis of 3 D-CRT. Enhanced CT was performed at three months after treatment. The clinical effects and adverse reactions of the two groups were compared. Serum levels of alpha-fetoprotein(AFP), vascular endothelial growth factor(VEGF), basic fibroblast growth factor(bFGF) and total bilirubin(TBIL) were measured before and after treatment. All patients were followed up for two years,and the survival rates at 6 months, 1 year and 2 years were recorded. Results At three months after treatment, the disease control rate in the observation group was higher than in the control group(67.4% vs. 48.8%, P<0.05). The serum levels of AFP, VEGF and bFGF in the two groups were decreased after treatment(P<0.05), and they were lower in the observation group than in the control group(P<0.05). After treatment, the TBIL level in the observation group was significantly higher than that before treatment(P<0.05). It was also higher in the observation group than in the control group after treatment(P<0.05). The incidence of hypertension and proteinuria in the observation group was higher than that in the control group(P<0.05). There was no significant difference in the incidence of nausea and vomiting, bone marrow suppression, elevated aminotransferase, abnormal coagulation function and hand-foot syndrome between the two groups(P>0.05). No cardiotoxicity was observed in both groups. The 1-year and 2-year survival rates of the observation group were 55.8% and 34.9% respectively, which were higher than those of the control group(32.6% and 13.9%, respectively)(P<0.05). Conclusion Three-dimensional radiotherapy combined with apatinib is effective in the treatment of AHCC. It can significantly improve the long-term survival rate of patients. The adverse reactions are tolerable. Such anti-tumor effect may be related to its inhibiting tumor angiogenesis.