HAIC在不可切除肝癌合并高流量肝动脉门静脉瘘的短期疗效及安全性

Short-term efficacy and safety of hepatic arterial infusion chemotherapy in the treatment of unresectable hepatocellular carcinoma with high-flow hepatic arterioportal shunts

目的观察FOLFOX方案肝动脉灌注化疗术(HAIC)在不可切除原发性肝细胞癌(HCC)合并高流量肝动脉门静脉瘘(APS)的短期疗效及安全性。方法回顾性收集2020年6月至2023年1月接受FOLFOX-HAIC治疗的不可切除HCC合并高流量APS患者的临床资料30例(HAIC组),并收集同期行肝动脉化疗栓塞术(TACE)治疗相同目标人群的临床资料30例(TACE组),对比两组间的APS有效率、肿瘤客观缓解率及不良事件发生率。结果HAIC组的APS有效率(83.3%vs 56.7%,χ^(2)=5.079,P=0.047)、肿瘤病灶客观缓解率(76.7%vs 46.7%,χ^(2)=5.711,P=0.017)及中位无进展生存期(PFS)(9.5个月vs 5.4个月,Log-rankχ^(2)=10.832,P=0.001)均优于TACE组。HAIC组术后患者血小板减少发生率高于TACE组(P<0.05),而TACE组术后患者谷丙转氨酶及碱性磷酸酶升高发生率高于HAIC组(P<0.05)。两组均未观察到严重不良事件发生。结论HAIC可有效改善不可切除HCC的高流量瘘口并控制肿瘤,且具备良好的安全性。

Objective To observe the short-term efficacy and safety of FOLFOX-HAIC in treatment of unresectable hepatocellular carcinoma combined with high-flow hepatic arterioportal shunts(APS).Methods The clinical data of 30 patients with unresectable hepatocellular carcinoma combined with high-flow APS who received FOLFOX-HAIC from Jun.2020 to Jan.2023 were retrospectively collected(HAIC group),and the clinical data of 30 patients in the same target population who underwent transcatheter arterial chemoembolization(TACE)during the same period were also collected(TACE group).The APS improvement rate,objective response rate of tumors and adverse reactions were compared between the two groups.Results The HAIC group showed significantly better results in terms of APS improvement rate(83.3%vs 56.7%,χ^(2)=5.079,P=0.047),objective response rate of tumor lesions(76.7%vs 46.7%,χ^(2)=5.711,P=0.017)and median progression-free survival(PFS)(9.5 months vs 5.4 months,Log-rankχ^(2)=10.832,P=0.001)compared to the TACE group.The incidence of thrombocytopenia in postoperative patients was significantly higher in the HAIC group than in the TACE group(P<0.05).On the other hand,the incidence of postoperative patients with increased alanine transaminase and alkaline phosphatase was significantly higher in the TACE group than in the HAIC group(P<0.05).No serious adverse events were observed.Conclusion HAIC is effective and safe treatment option for improving fistulas and controlling tumors in patients with unresectable hepatocellular carcinoma combined with APS.