索拉非尼联合与未联合TACE治疗巴塞罗那C期肝细胞癌患者预后分析

Sorafenib combined with transcatheter arterial chemoembolization or not in treatment of patients with hepatocellular carcinoma Barcelona Clinic Liver Cancer stage C

目的探讨索拉非尼联合与未联合经导管肝动脉栓塞化疗(TACE)治疗巴塞罗那C期肝细胞癌患者的预后。方法回顾分析2008年1月至2015年12月天津医科大学肿瘤医院连续收治的92例巴塞罗那C期肝细胞癌患者资料,男性82例,女性10例,平均年龄56.3岁。所有患者依据血管侵犯和其他器官转移分为血管侵犯组(n=24)、转移组(n=48)和血管侵犯合并转移组(n=20)。所有患者均服用索拉非尼,部分患者联合TACE。收集患者临床资料,随访患者生存情况。采用Kaplan-Meier法进行生存分析,采用log-rank检验比较生存率。多因素Cox回归分析患者预后影响因素。结果三组患者基线临床资料比较,差异无统计学意义(均P>0.05)。多因素Cox回归分析,甲胎蛋白>20μg/L(HR=1.90,95%CI:1.13~3.12)、碱性磷酸酶>125 U/L(HR=1.60,95%CI:1.03~2.49)、未联合TACE(HR=2.11,95%CI:1.23~3.54)是巴塞罗那C期肝细胞癌患者预后的独立危险因素。三组累积生存率比较,差异无统计学意义(P>0.05)。血管侵犯组中,联合TACE患者(n=4)的累积生存率优于未联合TACE患者(n=20),差异有统计学意义(均P<0.05)。结论与单独应用索拉非尼相比,索拉非尼联合TACE治疗巴塞罗那C期肝细胞癌患者预后更佳。亚组分析显示伴有血管侵犯患者联合TACE可有明显生存获益。

Objective To study the survival outcomes in patients with Barcelona Clinic Liver Cancer(BCLC)stage C hepatocellular carcinoma(HCC)treated with sorafenib combined with transcatheter arterial chemoembolization(TACE)versus sorafenib alone.Methods The data of 92 patients with BCLC stage C HCC at Tianjin Medical University Cancer Institute&Hospital from January 2008 to December 2015 were retrospectively studied.There were 82 males and 10 females.The average age was 56.3 years.Classified according to whether there were vascular invasion and/or distant metastasis,patients were divided into the vascular invasion group(n=24),the metastasis group(n=48),and the vascular invasion combined with metastasis group(n=20).All patients were treated with sorafenib,but some patients received combined treatment with TACE.The survival data of these patients on follow-up was collected.The Kaplan-Meier method was used for survival analysis,and the survival rates were compared by the log-rank test.Univariate and multivariate Cox analyses were used to determine the prognostic factors of patients’survival.Results There were no significant differences in the baseline clinical data among the three groups(all P>0.05).Multivariate Cox regression analysis showed that pre-treatment alpha fetal protein>20μg/L(HR=1.90,95%CI:1.13-3.12),alkaline phosphatase>125 U/L(HR=1.60,95%CI:1.03-2.49)and sorafenib alone(HR=2.11,95%CI:1.23-3.54)were independent risk factors of survival for these patients.There were no significant differences in the cumulative survival rates among the three groups(P>0.05).In the vascular invasion group,the cumulative survival rates of patients treated with combined sorafenib and TACE(n=4)were significantly higher than those treated with sorafenib alone(n=20)(P<0.05).Conclusion Compared with sorafenib alone,sorafenib combined with TACE resulted in better prognosis for patients with BCLC stage C HCC.Subgroup analysis showed that patients with vascular invasion had significantly better survival treated with combined sorafenib and TACE than sorafenib alone.