肝动脉化疗栓塞术联合索拉非尼治疗不同分型原发性肝癌并门静脉癌栓的临床疗效

Clinical Efficacy of transcatheter arterial Chemoembolization combined with Sorafenib in the Treatment of different Types of hepatocellular Carcinoma with Portal Vein Tumor Thrombus

目的观察肝动脉化疗栓塞术(TACE)联合索拉非尼治疗不同分型原发性肝癌(HCC)并门静脉癌栓(PVTT)的临床疗效及安全性。方法回顾性分析河南省人民医院2013年10月至2018年10月收治的90例HCC并PVTT患者临床资料,其中行TACE联合索拉菲尼治疗的50例患者为联合治疗组,单纯行TACE治疗的40例患者为对照组。比较不同门静脉癌栓分型患者的总生存时间(OS)、疾病控制率(DCR)和疾病进展时间(TTP)。结果Ⅰ型患者中,联合治疗组疾病控制率高于对照组,差异有统计学意义(P=0.046)。Ⅱ型患者中,联合治疗组疾病控制率高于对照组,差异有统计学意义(P=0.027)。Ⅲ型患者中,两组疾病控制率差异无统计学意义(P=0.087)。联合治疗组及对照组Ⅰ型患者肿瘤进展中位时间分别为9个月、5个月,差异有统计学意义(P=0.010),总生存期中位时间分别为23个月、16个月,差异有统计学意义(P=0.030);Ⅱ型患者肿瘤进展中位时间分别为8个月、5个月,差异有统计学意义(P=0.002),总生存期中位时间分别为17个月、13个月,差异有统计学意义(P=0.010);Ⅲ型患者肿瘤进展中位时间分别为4个月、3个月,差异无统计学意义(P=0.051),总生存期中位时间分别为10个月、7个月,差异无统计学意义(P=0.156)。结论TACE联合索拉菲尼用于门静脉癌栓Ⅰ型和Ⅱ型患者,可有效控制疾病进展,但在门静脉癌栓Ⅲ型患者中,索拉非尼联合TACE效果不明显。

Objective To evaluate the clinical efficacy and safety of transcatheter arterial chemoembolization(TACE)combined with sorafenib in the treatment of hepatocellular carcinoma(HCC)with portal vein tumor thrombus(PVTT).Methods The clinical data of 90 patients with HCC and PVTT from October 2013 to October 2018 in Henan People's Hospital were analyzed retrospectively.50 patients treated with TACE combined with sorafenib were the combined treatment group,the 40 patients treated with TACE alone were the control group.The total survival time(OS),disease control rate(DCR)and time to progression(TTP)of patients with different types of portal vein tumor thrombus were compared.Results In type I patients,the disease control rate of the combined treatment group was higher than that of the control group(P=0.046).In TypeⅡpatients,the disease control rate of the combined treatment group was higher than that of the control group(P=0.027).In typeⅢpatients,there was no significant difference in disease control rate between the two groups(P=0.087).The median time of tumor progression was 9 months in the combined treatment group and 5 months in the control group(P=0.010),and the median survival time was 23 months and 16 months,respectively(P=0.030).The median time of tumor progression in typeⅡpatients was 8 months and 5 months respectively(P=0.002).The median time of total survival was 17 months and 13 months respectively(P=0.010).The median time of tumor progression in typeⅢpatients was 4 months and 3 months,respectively,with no significant difference(P=0.051).The median time of total survival was 10 months and 7 months,respectively,with no significant difference(P=0.156).Conclusion TACE combined with sorafenib in patients with type I and type II portal vein tumor thrombus can effectively control the disease progression,but in patients with type III portal vein tumor thrombus,the effect of sorafenib combined TACE is not obvious.