TACE联合靶向药物治疗晚期原发性肝癌患者的疗效

Effect of TACE combined with targeted drug therapy in patients with advanced primary liver cancer

目的研究经肝动脉栓塞化疗(TACE)联合靶向药物治疗对晚期原发性肝癌患者生存期及相关临床并发症的影响。方法回顾性分析2016年4月至2021年4月安徽医科大学附属六安医院和丽水市中心医院收治的80例晚期原发性肝癌患者的临床资料,按照治疗方法不同将其分为研究组和对照组,研究组采用TACE联合靶向药物治疗,对照组单纯采用TACE治疗,比较两组临床疗效、肝功能、免疫功能及并发症发生情况。随访2年或以“全因死亡”作为随访终点,采用Kaplan Meier法绘制生存曲线,并采用Log-Rank检验。结果研究组客观缓解率、疾病控制率分别为45.00%(18/40)、80.00%(32/40),均高于对照组22.50%(9/40)、57.50%(23/40),组间差异具有统计学意义(P<0.05)。治疗后,两组丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、甲胎蛋白异质体(AFP-L3)水平均降低(P<0.05),且研究组上述指标水平均低于对照组(P<0.05);两组T细胞CD3^(+)、CD4^(+)水平、CD4^(+)/CD8^(+)均升高(P<0.05),CD8^(+)水平均降低(P<0.05),且研究组上述指标改善程度均优于对照组(P<0.05)。治疗期间,两组均出现不同程度皮疹、蛋白尿、发热、高血压、恶心呕吐等不良反应,但总发生率(32.50%vs.50.00%)差异无统计学意义(P>0.05)。截至随访结束,研究组死亡12例、对照组死亡22例,两组累积生存率(70.00%vs.45.00%)差异有统计学意义(Log-Rank P=0.024)。结论与单纯TACE比较,TACE联合靶向药物治疗晚期原发性肝癌可提高临床获益率,改善患者肝功能、免疫功能,且安全性有保障。

Objective To investigate the effects of transcatheter arterial chemoembolization(TACE)combined with targeted drug therapy on survival and related clinical complications in patients with advanced primary liver cancer.Methods Clinical data of 80 patients with advanced primary liver cancer admitted to Lu an Hospital Affiliated to Anhui Medical University and Lishui Central Hospital from April 2016 to April 2021 were retrospectively analyzed.According to treatment methods,they were divided into a research group and control group.The research group was treated with TACE combined with targeted drugs,while the control group was treated with TACE alone.The clinical efficacy,liver function,immune function,and complications were compared between the two groups.After 2 years of follow-up,“all-cause death”was used as the endpoint.Kaplan Meier method was used to draw the survival curve and Log-Rank test was used.Results The objective response rate and disease control rate of the research group were 45.00%(18/40)and 80.00%(32/40)respectively,which were higher than those of the control group,that is 22.50%(9/40)and 57.50%(23/40)respectively,and the difference between groups was statistically significant(P<0.05).After treatment,the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),and alpha-fetoprotein(AFP-L3)in 2 groups decreased(P<0.05),and the levels of the above indexes in the research group were lower than those in the control group(P<0.05);The levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)of T cells in both groups increased(P<0.05),and both levels of CD8^(+)decreased(P<0.05),and the improvement of the above indexes in the research group was greater than that in the control group(P<0.05).During treatment,gastrointestinal reactions such as rash,albuminuria,fever,hypertension,nausea and vomiting were observed in both groups,but there was no significant difference in the total incidence rate(32.50%VS 50.00%)(P>0.05).By the end of the follow-up,there were 12 deaths in the research group and 22 deaths in the control group.The cumulative survival rate between the two groups was significantly different(Log-Rank P=0.024)(70.00%VS 45.00%).Conclusions Compared with TACE alone,TACE combined with targeted drugs in the treatment of advanced primary liver cancer can increase the clinical benefit rate,and improve the liver function and immune function of patients,and the safety is guaranteed.