索拉非尼联合经导管肝动脉栓塞化疗在肝细胞肝癌合并微血管癌栓患者术后治疗中的效果观察

The analysis of short and long term efficacy of sorafenib combined with TACE in patients with hepatocellular carcinoma complicated with microvascular invasion

目的探讨索拉非尼联合经导管肝动脉栓塞化疗(TACE)在肝细胞肝癌合并微血管癌栓患者术后治疗的近远期疗效.方法选取2012年1月至2014年1月于我院收治的41例手术切除后病理诊断为肝细胞肝癌合并微血管癌栓患者作为研究对象,根据入院时间将其分为试验组21例和对照组20例.对照组在术后常规给予预防性TACE,而试验组则在此基础上联用索拉菲尼.酶联免疫吸附测定(ELISA)检测并比较2组患者治疗前后缺氧诱导因子(HIF)-1和血管内皮生长因子(VEGF)水平;记录并比较2组患者治疗过程中出现的不良反应;随访3年同时记录并对比分析2组患者的生活质量、生存情况及其影响因素.结果治疗前,2组患者VEGF和HIF-1水平比较差异无统计学意义(P>0.05);与治疗前比较,对照组治疗后患者VEGF(280±24)pg/mL与(259±32)pg/mL和HIF-1水平(480±45)pg/mL与(437±48)pg/mL均升高,试验组治疗后VEGF(156±21)与(260±30)pg/mL和HIF-1水平(300±36)pg/mL与(438±50)pg/mL均明显降低,差异均具有统计学意义(P<0.05);试验组术后生活质量明显优于对照组(60±10)与(47±8),且差异均具有统计学意义(P<0.05);试验组的3年生存率高于对照组(38%与25%),但差异无统计学意义(P>0.05);经单因素及多因素分析得知,肿瘤直径大小和分化程度是影响2组患者总生存率的独立危险因素(P<0.05).结论索拉非尼联合TACE可有效改善肝细胞肝癌合并微血管癌栓患者预后,其中肿瘤直径大小和分化程度是影响患者生存最重要的独立危险因素,须予以重视.

Objective To explore the short and long term efficacy of sorafenib combined with TACE in patients with hepatocellular carcinoma complicated with microvascular invasion.Methods A total of 41 cases of hepatocellular carcinoma complicated with microvascular invasion in our hospital from January 2012 to January 2014 were en-rolled in this study according to the time of admission,and they were randomly divided into the experimental group and the control group,each 21 and 20 in each group respectively.The control group were given prophylactic TACE routinely postoperative,while the experimental group were given sorafenib on the basis of that.HIF-1 and VEGF levels of two groups before and after treatment were detected and compared by ELISA.The adverse reactions and treat-ment process of two groups were recorded and compared.The quality of life,survival and its influence of the two groups were recorded and compared.Results Before treatment,there was no statistically significant differences in the levels of VEGF and HIF-1 in two groups(P>0.05).Compared with that before treatment,the VEGF(280±24)pg/mL vs(259±32)pg/mL and HIF-1 levels(480±45)pg/mL vs(437±48)pg/mL in control group were elevated after treatment,the VEGF(156±21)pg/mL vs(260±30)pg/mL and HIF-1 levels(300±36)pg/mL vs(438±50)pg/mL were significantly decreased in experimental group after treatment,all the differences were statistically significant(P<0.05).The quality of life in the experimental group was significantly better than that in the control group(60±10 vs 47±8),and the difference was statistically significant(P<0.05),and the 3-year survival rate of the experimental group was higher than that of the control group(38%vs 25%),but the difference was not statistically significant(P>0.05).Univariate and multivariate analysis revealed that tumor size and differentiation were independent risk factors for overall survival in the two groups(P<0.05).Conclusion Sorafenib combined with TACE can effectively improve the prognosis of patients with hepatocellular carcinoma combined with microvascular invasion,and the size and differentiation degree of tumor is the most important independent risk factors affecting the survival of patients with hepatocellular carcinoma,and we must pay more attention to it.