不可切除肝细胞癌患者肝动脉灌注化学治疗效果分析

Effect Analysis of Hepatic Artery Infusion Chemotherapy in Patients with Unresectable Hepatocellular Carcinoma

目的总结不可切除肝细胞癌患者接受肝动脉灌注化学治疗(HAIC)的疗效及安全性。方法回顾性收集2020年10月—2021年11月接受以HAIC为主要抗癌治疗的患者病历资料,评价手术转化率、客观缓解率(ORR)、疾病控制率(DCR)、生存时间及安全性。结果可评价患者29例(HAIC单独治疗9例,HAIC联合治疗20例),手术转化成功率10.34%,均为HAIC联合治疗患者;所有患者平均生存时间15.9个月[95%CI=(11.4,20.3)],ORR34.45%,DCR 89.66%;HAIC单独治疗患者与HAIC联合治疗患者生存时间、ORR及DCR比较,差异无统计学意义。亚组分析显示,Ⅰa-Ⅱa期、初始选择基于HAIC治疗、甲胎蛋白(AFP)≤200 ng·mL^(-1)患者ORR更高(Ⅰa-Ⅱa vs.Ⅱb-Ⅲa为80.00%vs.25.00%,P=0.036;初治vs.非初治为52.94%vs.8.33%,P=0.019;AFP≤200 ng·mL^(-1)vs.AFP>200 ng·mL^(-1)为58.33%vs.16.67%,P=0.045)。最常见HAIC相关不良反应为食欲下降,3—4级不良反应发生率19.35%,主要表现为肝损伤、血小板减少。结论不可切除肝细胞癌患者接受以HAIC为基础的抗癌治疗疗效佳,不良反应可接受。

Objective To analyze the efficacy and safety of hepatic artery infusion chemotherapy(HAIC)based therapy in patients with unresectable hepatocellular carcinoma.Methods Participants who underwent HAIC-based therapy from October 2020 to November 2021 were evaluated retrospectively by the conversion rate of surgery,objective response rate(ORR),disease control rate(DCR),overall survival(OS),and safety.Results In total,29 patients were included(HAIC-monotherapy,n=9;HAIC-multitherapy,n=20).A proportion of 10.34%of patients received surgery after HAIC-based therapy were all HAIC-multitherapy group.OS,ORR,and DCR of all patients were 15.9 months[95%CI=(11.4,20.3)],34.45%and 89.66%,respectively.There was no significant difference in OS,ORR,and DCR between HAIC-monotherapy and HAIC-multitherapy groups.Subgroup analysis showed that patients with CNLC Ia-IIa,initial treatment,and AFP≤200 ng·mL^(-1) had higher ORR significantly(Ⅰa-Ⅱa vs.Ⅱb-Ⅲa 80.00%vs.25.00%,P=0.036;initial treatment vs.non-initial treatment 52.94%vs.8.33%,P=0.019;AFP≤200 ng·mL^(-1) vs.AFP>200 ng·mL^(-1)58.33%vs.16.67%,P=0.045).The most common HAIC-related adverse reaction was anorexia.And the grade 3-4 adverse reactions accounted for 19.35%,which mainly manifested as liver injury and thrombocytopenia.Conclusion HAIC-based therapy for patients with unresectable hepatocellular carcinoma has satisfactory efficacy and acceptable adverse reactions.