血清VEGF、AFP检测对原发性肝癌PD-1抑制剂联合抗血管生成疗效的预测价值

Predictive Value of Serum VEGF and AFP Detection in the Efficacy of PD-1 Inhibitor Combined with Anti-angiogenic Drug in Patients with Primary Hepatocellular Carcinoma

目的探讨原发性肝癌患者接受信迪利单抗联合贝伐珠单抗治疗前后血管内皮生长因子(VEGF)和甲胎蛋白(AFP)水平变化及联合检测的意义。方法收集80例符合条件的晚期肝癌患者,均接受信迪利单抗联合贝伐珠单抗治疗,分别在治疗前、2周期治疗后检测血清AFP及VEGF水平的变化,同时按RECIST 1.1版判断近期疗效,直至疾病进展,分析近期疗效与血清VEGF、AFP水平变化之间的关系及联合检测的价值。结果80例患者中PR 19例,SD 40例,PD 21例,疾病有效率RR为23.75%,疾病控制率DCR为73.75%。无效组肿瘤分期IV期、多发性肿瘤者、肝功能Child-Pugh分级B级、肿瘤直径>3cm较有效组多,差异均有统计学意义(P<0.05)。与治疗前相比,治疗后血清VEGF及AFP的水平,PR患者显著降低(t=10.979,P=0.000;t=41.185,P=0.000),SD患者无明显差异(t=1.866,P=0.070;t=0.931,P=0.358),PD患者显著升高(t=-12.185,P=0.000;t=-8.001,P=0.000)。ROC曲线结果显示,VEGF、AFP及两者联合曲线下面积以两者联合最大。结论血清VEGF和AFP的检测有助于判断晚期肝癌患者信迪利单抗联合贝伐珠单抗联合治疗的疗效及可作为预测联合治疗预后的指标。

Objective The aim of this study was to explore the clinical value of expression levels of serum vascular endothelial growth factor(VEGF)and alpha fetal protein(AFP)in monitoring the response to the therapy with sintilimab combined with Bevacizumab for patients with primary hepatocellular carcinoma.Methods Eighty patients with advanced liver cancer were selected.All patients received sintilimab combined with Bevacizumab.Venous blood was collected before and after 2 cycles of treatment to detect serum VEGF and AFP levels.Meanwhile,the relationship among the change in expression level of serum VEGF,AFP and the responses to the combination therapy evaluated and the value of the combined testing.Results Among the 80 patients,there were 19 cases of PR,40 cases of SD,and 21 cases of PD.The RR was 23.75%,and the DCR was 73.75%.There were more patients with tumor stage IV,Child-Pugh grade B,tumor diameter>3cm and multiple tumors in the ineffective group than in the effective group,and the differences were statistically significant(P<0.05).Serum VEGF and AFP levels were significantly decreased in PR patients after treatment compared with those before treatment(t=10.979,P=0.000;t=41.185,P=0.000),there was no significant difference in SD patients(t=1.866,P=0.070;t=0.931,P=0.358),PD patients significantly increased(t=-12.185,P=0.000;t=-8.001,P=0.000).ROC curve results showed that the combined area of VEGF,AFP was the largest.Conclusion Detection of serum VEGF and AFP is helpful to judge the efficacy of sintilimab combined with bevacizumab in patients with advanced liver cancer and can be used as an indicator to predict the prognosis of combined therapy.