仑伐替尼联合肝动脉化疗栓塞治疗肝癌的疗效及预后影响因素分析

Clinical efficacy of lenvatinib combined with transcatheter arterial chemoembolization in the treatment of patients with advanced liver cancer and the prognostic factors

目的探讨晚期肝癌运用仑伐替尼联合肝动脉化疗栓塞(TACE)的治疗效果,并分析影响患者预后的相关因素。方法回顾性分析2021年6月至2024年1月南阳市第二人民医院收治的106例晚期肝癌患者的临床资料,所有患者均接受仑伐替尼联合TACE治疗,连续治疗6个月。记录所有患者治疗6个月后的临床疗效、中位总生存时间(OS)、分析不同性别、年龄、肿瘤个数、肿瘤直径、巴塞罗那(BCLC)分期、Child-Pugh分级、肝外转移、门静脉癌栓、甲胎蛋白(AFP)、中性粒细胞/淋巴细胞比值(NLR)患者的中位OS并采用Cox多因素回归分析法影响患者OS的相关因素。结果治疗6个月后,106例患者中0例完全缓解(CR)、37例部分缓解(PR)、40例疾病稳定(SD)、29例疾病进展(PD),客观缓解率(ORR)为34.90%,疾病控制率(DCR)为72.64%,随访截止至2024年6月1日,所有患者的中位OS为(14.82±3.71)个月,不同性别、年龄、肿瘤个数、肿瘤直径、BCLC分期、Child-Pug分级、有无肝外转移患者的中位OS比较差异均无统计学意义(P>0.05),而有无门静脉癌栓、不同中性粒细胞/淋巴细胞比值(NLR)患者的中位OS比较差异均有统计学意义(P<0.05);将OS作为因变量,将门静脉癌栓、NLR作为自变量纳入Cox回归分析,结果显示,门静脉癌栓(HR:5.092,95%CI:2.533~14.971)、NLR(HR:4.172,95%CI:1.302~13.921)均是影响晚期肝癌患者OS的独立因素(P<0.05)。结论仑伐替尼联合TACE治疗晚期肝癌患者的疗效较好。门静脉癌栓、NLR是影响晚期肝癌患者预后的独立因素,临床上应予以密切关注。

Objective To investigate the clinical efficacy of lenvatinib combined with transcatheter arterial chemoembolization(TACE)in patients with advanced liver cancer,and to analyze the related factors affecting the prognosisof patients.Methods The clinical data of 106 patients with advanced liver cancer admitted to Nanyang Second People'sHospital from June 2021 to January 2024 were retrospectively analyzed.All patients were treated with lenvatinibcombined with TACE,continuously for 6 months.The clinical efficacy after 6 months of treatment and the median overallsurvival(OS)of all patients was recorded.The median OS of patients with different gender,age,number of tumors,tumor diameter,Barcelona(BCLC)stage,Child-Pugh grade,extrahepatic metastasis,portal vein thrombosis,alpha fetoprotein(AFP),and neutrophil/lymphocyte ratio(NLR)were analyzed.Cox multivariate regression analysis was used to analyzethe related factors affecting the OS of patients.Results After treatment,there was 0 case of complete response(CR),37 cases of partial response(PR),40 cases of stable disease(SD),29 cases of progressive disease(PD),with the objectiveresponse rate(ORR)of 34.90%and disease control rate(DCR)of 72.64%.The patients were followed up untilJune 1,2024.The median OS for all the patients was(14.82±3.71)months.The median OS showed no statistically significantdifference between/among patients with different gender,age,number of tumors,tumor diameter,BCLC stage,Child-Pug grade,and patients with or without extrahepatic metastasis(P>0.05),but statistically significant difference betweenpatients with and without portal vein tumor thrombus and among patients with different NLR(P<0.05).Taking OSas the dependent variable and portal vein tumor thrombus and NLR as independent variables,Cox regression analysisshowed that portal vein tumor thrombus(HR:5.092,95%CI:2.533-14.971)and NLR(HR:4.172,95%CI:1.302-13.921)were independent factors affecting OS in patients with advanced liver cancer(P<0.05).Conclusion The efficacy of lenvatinibcombined with TACE in the treatment of patients with advanced liver cancer is significant,and portal vein tumorthrombus and NLR are independent factors affecting the prognosis of advanced liver cancer patients,which should bepaid close attention to clinically.