DEB-TACE联合仑伐替尼对不可切除中晚期肝癌微环境和疗效影响

Effect of DEB-TACE combined with Lenvatinib in the treatment of unresectable middle and advanced liver cancer

目的探讨载药微球肝动脉化疗栓塞(DEB-TACE)联合仑伐替尼治疗不可切除中晚期肝细胞癌(HCC)的疗效和安全性。方法选择海安市人民医院肿瘤科2021年1月—2022年3月收治的不可切除中晚期HCC患者70例,随机分为观察组和对照组;在口服仑伐替尼的基础上,观察组采用DEB-TACE治疗,对照组采用碘化油肝动脉化疗栓塞术(cTACE)治疗;观察治疗前后肿瘤内环境和肝生化指标的变化,以及疗效和安全性指标。结果观察组治疗后3个月的ORR、DCR和1年生存率分别为77.14%、91.43%和57.14%,高于对照组的54.29%、71.43%和37.14%;观察组的1年复发率为20.00%,低于对照组的42.86%,差异均有统计学意义(χ^(2)=4.086,3.695,3.369,4.879,均P<0.05)。治疗3个月后,观察组的血清缺氧诱导因子-1α(HIF-α)、肿瘤特异性生长因子(TSGF)和肝细胞生长因子(HGF)水平为(308.47±32.65)pg/mL、(54.36±5.81)U/mL和(4.37±0.83)μg/L,低于对照组的(382.45±38.39)pg/mL、(63.49±6.34)U/mL和(5.08±0.96)μg/L,差异均有统计学意义(t=7.516,8.342,8.754,均P<0.05);血清丙氨酸氨基转移酶(ALT)和总胆红素(TBil)为(58.83±6.73)U/L和(21.69±3.12)μmol/L,低于对照组的(72.56±7.45)U/L和(23.25±3.18)μmol/L,白蛋白(Alb)为(34.56±2.37)g/L,高于对照组的(32.89±2.29)g/L,差异均有统计学意义(t=5.163,4.746,3.725,均P<0.05)。观察组的不良反应发生率略低于对照组,差异无统计学意义(P>0.05)。结论DEB-TACE联合仑伐替尼治疗不可切除中晚期HCC,能改善肿瘤病灶内环境降,减轻肝损伤,提高临床治疗效果,安全性较高。

Objective To investigate the efficacy and safety of DEB-TACE combined with lenvatinib in the treatment of unresectable advanced hepatocellular carcinoma(HCC).Methods Seventy patients with unresectable advanced HCC admitted to the Department of Oncology,Haian People's Hospital from January 2021 to March 2022 were randomly divided into an observation group and a control group.On the basis of oral lenvatinib,the observation group was treated with DEB-TACE,and the control group was treated with iodized oil hepatic arterial chemoembolization(cTACE).The changes of tumor internal environment and liver function indexes,as well as the efficacy and safety indexes were observed before and after treatment.Results The 3-month objective response rate(ORR),disease control rate(DCR)and 1-year survival rate of the observation group were 77.14%,91.43%and 57.14%,respectively,which were higher than those of 54.29%,71.43%and 37.14%in the control group.The 1-year recurrence rate of the observation group was 20.00%,which was lower than that of the control group(42.86%),and the difference was statistically significant(χ^(2)=4.086,3.695,3.369,4.879,all P<0.05).After 3 months of treatment,the serum levels of hypoxia-inducible factor-1α(HIF-α),tumor-specific growth factor(TSGF)and hepatocyte growth factor(HGF)in the observation group were 308.47±32.65 pg/mL,54.36±5.81 U/mL,and 4.37±0.83μg/L,respectively.They were lower than those of 382.45±38.39 pg/mL,63.49±6.34 U/mL,and 5.08±0.96μg/L in the control group,and the differences were statistically significant(t=7.516,8.342,8.754,all P<0.05).The serum alanine aminotransferase(ALT)and total bilirubin(TBil)levels in the observation group were 58.83±6.73 U/L and 21.69±3.12μmol/L,respectively,which were lower than those of 72.56±7.45 U/L and 23.25±3.18μmol/L in the control group,whereas the albumin(Alb)level in the observation group was 34.56±2.37 g/L,which was higher than that of 32.89±2.29 g/L in the control group,and the differences were statistically significant(t=5.163,4.746,3.725,all P<0.05).The incidence of adverse reactions in the observation group was slightly lower than that in the control group,without statistical significance(P>0.05).Conclusion DEB-TACE combined with lenvatinib in the treatment of unresectable middle and advanced HCC can improve the internal environment of tumor lesions,reduce liver damage,and improve clinical treatment effect with high safety.