射频消融术联合阿帕替尼治疗肝细胞癌复发患者的疗效及预后因素研究

Study on the effect of RFA combined with apatinib on the efficacy and prognosis of patients with HCC recurrence

目的:目的探讨射频消融术(RFA)联合阿帕替尼对复发性肝细胞癌(HCC)的治疗价值,分析该方案对患者预后的影响。方法:将我院2017年9月至2019年5月收治的复发性HCC患者98例,根据随机数字表法,分成观察组与对照组各49例。对照组患者单纯行RFA治疗,观察组患者采用RFA联合阿帕替尼方案。比较两组患者疾病缓解率;分别在治疗前后检测血清血管内皮生长因子(VEGF)、E-钙黏蛋白(EC)、基质金属蛋白酶(MMP)以及血清总胆红素(TBil)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)水平;观察两组患者不良事件发生情况。随访18个月,经COX多因素模型分析联合方案对患者预后的影响。结果:观察组患者总缓解率为77.55%与对照组的71.43%比较,差异无显著性意义(P>0.05)。两组患者治疗后血清VEGF、MMP、TBil、ALT、AST水平均低于治疗前,且观察组患者各项指标降低优于对照组;两组患者治疗后血清EC水平均高于治疗前,且观察组优于对照组(P<0.05)。随访18个月观察组患者总生存率为85.71%高于对照组的67.35%,P<0.05;观察组患者死亡率为14.29%低于对照组的32.65%(P<0.05)。观察组患者不良事件发生率为20.41%低于对照组的16.33%,但无统计学差异(P>0.05)。COX多因素分析显示,门静脉侧支循环(RR=3.619,95%CI:1.312~9.983)与使用阿帕替尼(RR=0.898,95%CI:0.814~0.991)是预后的影响因素(P<0.05)。结论:复发性HCC患者经RFA联合阿帕替尼治疗可能通过调节血清VEGF、EC、MMP水平,进一步改善患者肝功能,提高中期生存率,且使用阿帕替尼对延长患者生存期有益,但RFA联合阿帕替尼的近期疗效与单用RFA治疗接近。

Objective:To explore the therapeutic value of radiofrequency ablation(RFA)combined with apatinib in the treatment of recurrent primary liver cancer(HCC)and observe the effect of the program on its prognosis.Methods:A total of 98 patients with recurrent HCC admitted to our hospital from September 2017 to May 2019 were enrolled.According to the random number table method,they were divided into observation group and control group with 49 cases each.The control group was treated with RFA alone,and the observation group was treated with RFA combined with apatinib.The disease remission rate of the two groups was compared,and the serum vascular endothelial growth factor(VEGF),E cadherin(EC),matrix metalloproteinase(MMP),and serum total bilirubin(TBil)and alanine amino acid were measured before and after treatment.The levels of transferase(ALT)and aspartate aminotransferase(AST)were observed to observe the incidence of adverse events in the two groups.A prospective follow up of 18 months was conducted to analyze the midterm prognosis of the patients,and the factors affecting the prognosis of the patients were analyzed by COX multivariate model.Results:The total remission rate of the observation group(77.55%)was not different from that of the control group(71.43%)(P>0.05).Serum VEGF,MMP,TBil,ALT,AST levels after treatment in the two groups were lower than before treatment,and the observation group was lower than the control group,the serum EC levels after treatment in the two groups were higher than before treatment,and the observation group was higher than the control group(P<0.05).The overall survival rate of the observation group(85.71%)after 18 months of follow up was higher than that of the control group(67.35%),and the mortality rate of the observation group(14.29%)was lower than that of the control group(32.65%)(P<0.05).There was no difference in the incidence of adverse events between the observation group(20.41%)and the control group(16.33%)(P>0.05).COX multivariate analysis showed that portal vein collateral circulation(RR=3.619,95%CI:1.312-9.983)and the use of apatinib(RR=0.898,95%CI:0.814-0.991)were prognostic factors(P<0.05).Conclusion:The treatment of recurrent HCC patients with RFA combined with apatinib may further improve liver function and increase the medium term survival rate by adjusting serum VEGF,EC,and MMP levels.The use of apatinib has a protective effect on the prognosis,but RFA combined with apatinib The short term efficacy of tinib is similar to that of RFA alone.