PD-1抗体联合胸腺肽α1、肝动脉灌注化疗治疗原发性肝癌合并门静脉癌栓的疗效观察

Observation on the therapeutic effect of PD-1 antibody combined with thymosinα1 and HAIC in treating primary liver cancer with portal vein thrombosis

目的探究程序性死亡蛋白-1(PD-1)抗体联合胸腺肽α1、肝动脉灌注化疗(HAIC)治疗原发性肝癌合并门静脉癌栓(PVTT)的疗效。方法选择2021年8月—2022年8月石家庄市第五医院介入医学科治疗的原发性肝癌合并PVTT患者50例,以随机数字表法分为PD-1组(n=25)和对照组(n=25)。对照组给予胸腺肽α1与HAIC治疗,PD-1组给予PD-1抗体联合胸腺肽α1、HAIC治疗。比较2组患者客观缓解率、肝功能指标、血清肿瘤标志物、免疫功能指标。结果PD-1组的客观缓解率高于对照组(48.00%vs.20.00%,χ^(2)/P=4.367/0.037)。治疗6周、12周后,2组Alb均升高,TBil、ALT均降低,且治疗12周后PD-1组升高/降低幅度显著大于对照组(t/P=2.897/0.006、3.424/<0.001、2.658/<0.001);2组患者甲胎蛋白(AFP)、胰岛素样生长因子结合蛋白-2(IGFBP-2)均降低,且治疗12周后PD-1组低于对照组(t/P=3.934/<0.001、5.992/<0.001);2组患者CD8^(+)均降低,CD4^(+)/CD8^(+)均升高,且治疗12周后PD-1组降低/升高幅度大于对照组(t/P=3.110/<0.001、2.414/0.020)。结论PD-1抗体联合胸腺肽α1、HAIC治疗能够改善原发性肝癌合并PVTT患者的肝功能和免疫功能,降低血清肿瘤标志物水平,延缓肿瘤进展,疗效显著。

Objective To investigate the therapeutic effect of programmed death-1(PD-1)antibody combined with thymosinα1 and hepatic arterial infusion chemotherapy(HAIC)in treating primary liver cancer with portal vein tumor thrombosis(PVTT).Methods Fifty patients with primary liver cancer complicated with portal vein thrombosis admitted for treatment from August 2021 to August 2022 were randomly separated into an PD-1 group(n=25)and a control group(n=25)using a random number table method.The control group was treated with thymosinα1 and HAIC,while the PD-1 group was treated with PD-1 antibody combined with thymosinα1 and HAIC.The objective response rate,liver function indicators,serum tumor markers,and immune function indicators were compared between the two groups.Results The objective response rate of PD-1 group was higher than that of control group(48.00%vs.20.00%,χ^(2)/P=4.367/0.037).After 6 and 12 weeks of treatment,both groups showed an increase in albumin(Alb)level,and PD-1 group was higher than that in control group after 12 weeks of treatment.Both groups showed a decrease in total bilirubin(TBil)and alanine aminotransferase(ALT),and PD-1 group was lower than those in control group after 12 weeks of treatment(t/P=2.897/0.006,3.424/<0.001,2.658/<0.001).After 6 and 12 weeks of treatment,both groups showed a decrease in alpha fetoprotein(AFP)and insulin-like growth factor binding protein-2(IGFBP-2),and the PD-1 group was lower than those in control group after 12 weeks of treatment(t/P=3.934/<0.001,5.992/<0.001).After 6 and 12 weeks of treatment,both groups showed a decrease in CD8^(+),and PD-1 group was lower than the control group after 12 weeks of treatment.CD4^(+)/CD8^(+)increased in both groups,and PD-1 group was higher than the control group after 12 weeks of treatment(t/P=3.110/<0.001,2.414/0.020).Conclusion PD-1 antibody combined with thymosinα1 and HAIC therapy can improve liver and immune functions,reduce AFP level,delay tumor progression,and have great therapeutic effects in patients with primary liver cancer complicated with PVTT.