改变肿瘤酸性微环境肝动脉化疗栓塞术治疗肝细胞癌的疗效与安全性

Efficacy and safety of tumor acidic microenvironment-targeted hepatic arterial chemoembolization for treating hepatocellular carcinoma

目的探讨靶向肿瘤内高乳酸环境肝动脉化疗栓塞术(TILA-TACE)用于治疗肝细胞癌(HCC)的疗效和安全性。方法通过回顾分析2016年9月至2020年9月于赣州市人民医院接受TILA-TACE治疗的HCC患者的临床资料,对TILA-TACE术后的近期疗效和靶病灶直径变化进行评估,统计治疗相关不良反应,并随访总体生存时间。结果共纳入67例患者,平均年龄为(51.2±11.7)岁,其中男60例。67例患者肿瘤分期为BCLC 0、A、B、C期,分别为4、15、11、37例;CNLCⅠa、Ⅰb、Ⅱa、Ⅱb、Ⅲa、Ⅲb分别12、7、4、7、22、15例。首次TILA-TACE后基于mRECIST标准,8例(11.9%)患者达完全缓解(CR),28例(41.8%)达部分缓解(PR)。客观缓解率(ORR)为53.7%(95%CI:41.5%~66.0%),疾病控制率(DCR)为82.1%(95%CI:72.7%~91.5%)。截至2024年4月1日,中位随访时间10个月。中位生存时间12.1个月(95%CI:6.4~17.8个月)。1、2、3、5年的累积生存率分别为51.3%、29.5%、20.2%和7.1%。主要不良反应包括腹痛(79.1%)、丙氨酸氨基转移酶升高(35.8%)和血清胆红素升高(32.8%)。结论TILA-TACE治疗肝脏肿瘤显示出局部抗肿瘤疗效,安全性可控,但确切疗效还有待多中心、大样本、前瞻性随机对照研究评估。

Objective To evaluate the efficacy and safety of tumor acidic microenvironment-targeted hepatic arterial chemoembolization(TILA-TACE)for treating hepatocellular carcinoma(HCC).Methods A retrospective analysis was performed on clinical data from HCC patients who received TILA-TACE at Ganzhou People′s Hospital from September 2016 to September 2020.The short-term efficacy,target lesion diameter changes,treatment-related adverse effects,and overall survival time were assessed.Results A total of 67 patients were included,with a mean age of(51.2±11.7)years,including 60 males.Tumor staging based on BCLC was as follows:Stage 0(4 patients),Stage A(15 patients),Stage B(11 patients),and Stage C(37 patients).CNLC staging was:Ⅰa(12 patients),Ⅰb(7 patients),Ⅱa(4 patients),Ⅱb(7 patients),Ⅲa(22 patients),andⅢb(15 patients).Based on mRECIST criteria,8 patients(11.9%)achieved complete response(CR)and 28 patients(41.8%)achieved partial response(PR)after the initial TILA-TACE.The objective response rate(ORR)was 53.7%(95%CI:41.5%-66.0%),and the disease control rate(DCR)was 82.1%(95%CI:72.7%-91.5%).As of April 1,2024,the median follow-up time was 10 months.The median survival time was 12.1 months(95%CI:6.4-17.8 months).The 1-year,2-year,3-year,and 5-year cumulative survival rates were 51.3%,29.5%,20.2%,and 7.1%,respectively.Major adverse reactions included abdominal pain(79.1%),elevated alanine aminotransferase(35.8%),and elevated serum bilirubin(32.8%).Conclusion TILA-TACE demonstrates local anti-tumor efficacy for liver tumors with controllable safety.However,the precise efficacy requires further evaluation through multicenter,large-scale,prospective randomized controlled studies.