TACE联合阿帕替尼治疗肝细胞肝癌伴门静脉癌栓疗效研究

Efficacy analysis of transarterial chemoembolization combined with Apatinib in hepatocellular carcinoma with portal vein tumor thrombus

目的评价经导管肝动脉化疗栓塞术(TACE)联合阿帕替尼治疗肝细胞肝癌(HCC)伴门静脉癌栓(PVTT)的疗效,为临床治疗提供依据。方法选择48例HCC伴PVTT患者,其中男性43例,女性5例;年龄43~68岁,平均年龄56.2岁;慢性乙型肝炎35例,慢性丙型肝炎3例,酒精肝病4例,其他6例;巨块型肿瘤27例,浸润型肿瘤11例,多发结节型肿瘤10例。依据治疗方法的不同分为2组。A组25例接受TACE联合阿帕替尼治疗,其中男性23例,女性2例;年龄43~65岁,平均年龄54.1岁。B组23例接受单纯TACE治疗,其中男性20例,女性3例;年龄48~68岁,平均年龄57.3岁。A组再按照PVTT的不同类型分为A1组、A2组:主干PVTT组(A1组)11例,分支PVTT组(A2组)14例。评价指标为客观缓解率(ORR)、中位总生存时间(MOS)、中位肿瘤进展时间(MTTP)。结果 3个月内疾病控制指标ORR值比较,A组与B组差异无统计学意义(36.0%vs 30.4%;χ^2=0.328,P> 0.05);A1组与A2组比较,差异无统计学意义(18.2%vs 50.0%;χ^2=7.317,P> 0.05)。各组间MOS相比较,B组MOS短于A组(7.8个月vs 12.1个月),差异有统计学意义(χ^2=4.753,P <0.05);A1组MOS短于A2组(5.1个月vs 13.2个月),差异有统计学意义(χ^2=14.579,P <0.05)。各组间MTTP相比较,B组MTTP短于A组(2.7个月vs 5.2个月),差异有统计学意义(χ^2=12.8,P <0.05);A1组MTTP短于A2组(2.8个月vs 5.8个月),差异有统计学意义(χ^2=14.2,P <0.05)。结论 TACE联合阿帕替尼治疗伴PVTT的HCC安全有效,优于单纯TACE,延长其MOS和MTTP;伴有分支PVTT的HCC的疗效优于伴有主干PVTT的HCC。

Objective To evaluate the efficacy of transarterial chemoembolization(TACE) combined with Apatinib in treatment of hepatocellular carcinoma(HCC) patients with portal vein tumor thrombus(PVTT), and provide basis for clinic treatment.Methods A total of 48 HCC patients with PVTT were enrolled, which included 43 males and 5 females, aged 43-68 years old with mean age of 56.2 years old. There were 35 cases of chronic hepatitis B, 3 of chronic hepatitis C, 4 of alcoholic liver disease and 6 of other diseases;27 cases of massive tumors, 11 of invasive tumors and 10 of multiple nodular tumors.According to different treatment methods, the patients were divided into group A(n = 25, which included 23 males and 2 females,aged 43-65 years old with mean age of 54.1 years old, performed TACE combined with Apatinib) and group B(n = 23, which included 20 males and 3 females, aged 48-68 years old with mean age of 57.3 years old, performed TACE therapy).According to different types of PVTT, group A was divided into 2 subgroups, the main PVTT group(group A1, n = 11) and branch PVTT group(group A2, n = 14). The evaluation indexes included objective response rate(ORR), median overall survival time(MOS) and median time to progression(MTTP). Results The ORR value of disease control indicators in 3-month was no statistically significant difference between group A and group B(36.0 % vs 30.4 %;χ^2= 0.328, P > 0.05), and no statistically significant difference between group A1 and group A2(18.2 % vs 50.0 %;χ^2= 7.317, P > 0.05). For MOS, group B was shorter than that of group A(7.8-month vs 12.1-month), and was statistically significant difference(χ^2= 4.753, P < 0.05);group A1 was shorter than that of group A2(5.1-month vs 13.2-month), and was statistically significant difference(χ^2= 14.579, P < 0.05). For MTTP, group B was shorter than that of group A(2.7-month vs 5.2-month), and was statistically significant difference(χ^2=12.8, P < 0.05);group A1 was shorter than that of group A2(2.8-month vs 5.8-month), and was statistically significant difference(χ^2= 14.2, P < 0.05). Conclusion It is demonstrated that TACE combined with Apatinib in treatment of HCC with PVTT is safer and more effective than TACE therapy, which prolongs MOS and MTTP. The combined therapy is more effective in HCC with branch PVTT than HCC with main PVTT.