经肝动脉化疗栓塞联合索拉非尼治疗中晚期肝癌合并肝破裂出血的有效性及安全性

Efficacy and safety of transarterial chemoembolization combined with sorafenib in treatment of advanced liver cancer complicated with liver rupture and bleeding

目的探讨肝癌动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)联合索拉非尼(sorafenib)治疗中晚期肝癌合并肝破裂出血的有效性及安全性。方法回顾性分析2008年1月至2019年12月在温州医科大学附属第五医院诊治的69例中晚期肝癌伴肝破裂出血患者的临床资料。根据治疗方式不同分为联合组(TACE联合sorafenib治疗,n=32)和对照组(行单纯TACE治疗,n=37)。比较两组疾病控制率、再出血和并发症发生率,计算并比较两组患者的肿瘤无进展生存时间(progression-free survival,PFS)和总生存时间(overall survival,OS)。结果联合组患者治疗后疾病控制率[24(75.0%)]明显高于对照组[21(56.7%)],差异有统计学意义(P=0.02);两组间再出血发生率,以及腹痛、发热、肝功能损害发生率均无统计学差异(均P>0.05)。联合组中位PFS(12个月vs 6个月,χ^(2)=3.8,P=0.04)和OS(23个月vs 9个月,χ^(2)=4.6,P=0.03)均优于对照组。结论TACE联合索拉非尼治疗中晚期肝癌合并肝破裂出血是一种有效、安全的治疗方案。

Objective To investigate the efficiency and safety of transcatheter arterial chemoembolization(TACE)combined with sorafenib in treatment of advanced liver cancer complicated with liver rupture and bleeding.Methods The clinical data of 69 patients admitted in the Fifth Affiliated Hospital of Wenzhou Medical University between Jan.2008 and Dec.2019 were retrospectively analyzed.Patients were divided into TACE+sorafenib treatment group(combination group,n=32)and TACE treatment group(control group,n=37).The disease control rate,re-bleeding and complication rate were compared between two groups.The tumor progression-free survival(PFS)and overall survival(OS)between two groups were calculated.Result The disease control rate in combination group was significantly higher than that in control group[24(75.0%)vs 21(56.8%),P=0.02].There was no significant difference in the incidence of re-bleeding,abdominal pain,fever or liver function damage between two groups(P>0.05).The median PFS(12 months vs 6 months,χ^(2)=3.8,P=0.04)and OS(23 months vs 9 months,χ^(2)=4.6,P=0.03)in combination group were significantly longer than those in control group.Conclusion TACE combined with sorafenib is an efficiet and safe treatment for advanced liver cancer complicated with liver rupture and bleeding.