HAIC序贯TAE治疗不可切除肝细胞癌的安全性和有效性

The safety and efficacy of sequential hepatic arterial infusion chemotherapy and transarterial embolization for unresectable hepatocellular carcinoma

目的 评估肝动脉灌注化疗(HAIC)序贯肝动脉栓塞术(TAE)治疗不可切除肝细胞癌的安全性及有效性。方法 收集2020年4月至2021年4月采用HAIC序贯TAE治疗的25例肝癌患者的临床资料,以ALBI评分评估患者肝功能变化情况,记录术后出现的不良反应。根据改良实体瘤疗效评价标准(mRECIST)评估肿瘤客观缓解率(ORR)、疾病控制率(DCR),并随访患者的疾病进展时间(TTP)和生存时间(OS)。结果 患者首次治疗后3个月ALBI评分(-2.29±0.53)与术前(-2.32±0.44)相比,差异无统计学意义(t=-0.223,P=0.825)。主要不良反应包括肝功能损伤、骨髓抑制、腹痛、恶心呕吐、发热等,4例患者出现Ⅲ级不良反应(3例ALT升高,1例骨髓抑制),其余均为Ⅰ~Ⅱ级不良反应。术后6周ORR、DCR分别为68%、92%,术后12周ORR、DCR分别为72%、88%,中位TTP为271 d(95%CI:115.9~426.0),中位OS为510 d(95%CI:491.5~528.5)。结论 HAIC序贯TAE治疗不可切除肝癌临床疗效显著,具有良好的耐受性,是安全可行的。

Objective To evaluate the safety and efficacy of sequential hepatic arterial infusion chemotherapy(HAIC)and transarterial embolization(TAE)in the treatment of unresectable hepatocellular carcinoma(HCC).Methods The clinical data of 25 patients with HCC,who received sequential HAIC and TAE during the period from April 2020 to April 2021,were collected.ALBI score was used to evaluate the changes of liver functions,and the postoperative adverse reactions were recorded.The tumor objective remission rate(ORR)and disease control rate(DCR)were evaluated by the modified response evaluation criteria in solid tumor(mRECIST).All the patients were followed up to check the time to progression(TTP)and overall survival(OS).Results The ALBI score obtained at 3 months after the initial treatment was(-2.29+0.53)points,which was not significantly different from the preoperative(-2.32±0.44)points(t=-0.223,P=0.825).The main adverse reactions included liver function damage,suppression of bone marrow,abdominal pain,nausea and vomiting,fever,etc.Four patients developed grade II adverse reactions(including elevated alanine aminotransferase in 3 patients and suppression of bone marrow in one patient),and the remaining patients had grade I-II adverse reactions.At 6 weeks after treatment the ORR and DCR were 68%and 92%respectively,and at 12 weeks after treatment the ORR and DCR were 72%and 88%respectively.The median TTP was 271 days(95%CI=115.9-426.0)and the median OS was 510 days(95%CI=491.5-528.5).Conclusion For the treatment of unresectable HCC,sequential HAIC and TAE is clinically safe and effective,and the patients can well tolerate this treatment.