程序性死亡受体1抑制剂联合经导管动脉化疗栓塞术治疗巨块型肝癌的疗效及安全性研究

Efficacy and safety of programmed death-1 inhibitor combined with transcatheter arterial chemoembolization in the treatment of huge primary liver cancer

目的探讨程序性死亡受体1(PD1)抑制剂联合经导管动脉化疗栓塞术(TACE)治疗巨块型肝癌的有效性、安全性。方法回顾性分析2016年6月至2019年12月浙江省丽水市中心医院就诊的31例巨块型肝癌患者的临床资料。肿块最长径10.1~18.8(14.2±2.3)cm。根据治疗方法分为TACE组(n=18)和联合组(TACE术后1周开始给予第1次200 mg PD1抑制剂治疗,每21天给药1次,n=13)。对患者进行随访,采用Mann-Whitney U检验比较两组患者的肿瘤控制有效率(DCR),以Kaplan-Meier法计算中位生存时间(OS)及肿瘤无进展时间(PFS)。结果联合组的DCR(53.8%,7/13)高于TACE组(22.2%,4/18),差异有统计学意义(Z=-2.13,P=0.04)。联合组的中位PFS(5.0个月)较TACE组(3.0个月)延长,差异有统计学意义(χ^(2)=4.39,P=0.04),联合组中位OS(15.0个月)较TACE组(9.0个月)延长,差异有统计学意义(χ^(2)=5.51,P=0.02)。结论PD1抑制剂可有效提高TACE治疗巨块型肝癌患者疗效,PD1抑制剂联合TACE治疗巨块型肝癌是一种安全、有效的治疗方案。

Objective To investigate the efficacy and safety of programmed death-1(PD1)inhibitor combined with transcatheter arterial chemoembolization(TACE)in the treatment of huge primary liver cancer.Methods From June 2016 to December 2019,the clinical data of 31 patients with huge primary liver cancer enrolled in the Central Hospital of Lishui were retrospectively collected and analyzed.The tumor size ranged from 10.1 to 18.8 cm,with an average of(14.2±2.3)cm.The patients were divided into TACE group(TACE treatment,18 cases)and combined group(one week after TACE,patients receiving a dose of 200 mg PD1 inhibitor administration every 21 days,13 cases),according to whether patients receiving PD1 inhibitors.The patients were followed up.The disease control rate(DCR)were compared between the two groups using Mann-Whitney U test.The median overall survival(OS)and progression free survival(PFS)were calculated by Kaplan-Meier method.Results The DCR in combined group(53.8%,7/13)was higher than that in TACE group(22.2%,4/18),and the difference was statistically significant(Z=-2.13,P=0.04).The median PFS(5.0 months)in combined group was longer than that in TACE group(3.0 months),the difference was statistically significant(χ^(2)=4.39,P=0.04).The median OS(15 months)in combined group was longer than that in control group(9 months),and the difference was statistically significant(χ^(2)=5.51,P=0.02).Conclusion The combine PD1 inhibitors with TACE is an effective and safe therapy for huge primary liver cancer.