介入化疗栓塞联合阿帕替尼治疗局部中晚期肝癌的临床观察

Clinical observation on interventional chemoembolization combined with Apatinib in treatment of locally advanced hepatic cancer

目的评价介入化疗栓塞联合阿帕替尼治疗局部中晚期肝癌的有效性及安全性。方法自2015年5月—2016年10月郑州人民医院肿瘤内科收治局部中晚期肝癌患者35例,予介入化疗栓塞治疗,同时术后予阿帕替尼片(425 mg/d)口服靶向治疗,每4周为1疗程,直至疾病进展或出现不可耐受的不良反应,两个疗程后(2个月)分析其近期疗效及远期疗效并观察不良反应。结果治疗2个月后完全缓解1例、部分缓解4例、稳定23例、进展12例,客观缓解率为14.29%,疾病控制率为80%,中位无进展生存期为2.1年、中位总生存时间4.6年,1、2年总生存率分别为89%、57%。患者治疗期间出现不良反应以I、II级为主,主要是发热(45.7%)、乏力(85.7%)、肝功能异常(57.1%)、皮疹(22.9%)、手足反应(11.4%)、腹泻(42.9%)、胃肠道反应(57.1%)、高血压(14.3%)、蛋白尿(8.6%),予对症治疗后均可恢复。结论介入化疗栓塞联合阿帕替尼治疗局部晚期肝癌患者,疗效确切、不良反应可控,值得临床进一步推广。

Objective To evaluate the efficacy and safety of interventional chemoembolization combined with Apatinib in the treatment of locally hepatic cancer.Methods Thirty-five patients with locally advanced hepatic cancer admitted in the people’s hospital of Zhengzhou from May 2015 to October 2016 were enrolled in this study.The patients were treated with interventional chemoembolization,and postoperative oral administration of Nepal tablet(425 mg/d),every 4 weeks for a course,until disease progression or an intolerable adverse reaction occurs.The short-term and long-term effects were analyzed and the adverse reactions were observed after 2 courses.Results After 2 months of treatment,1 case was completely relieved,4 cases were partially relieved,23 cases were stable,while 12 cases were progressing.The disease control rate was 80%,the objective remission rate was 14.29%,and the median progression-free survival period was 2.1 years,the median overall survival time was 4.6 years,and the 1-year and 2-year overall survival rates were 89%and 57%,respectively.Grade I and II were the main adverse reactions during treatment,including fever(45.7%),fatigue(85.7%),abnormal liver function(57.1%),skin rash(22.9%),hand-foot reaction(11.4%),diarrhea(42.9%),gastrointestinal reaction(57.1%),hypertension(14.3%)and proteinuria(8.6%),which could be recovered after symptomatic treatment.Conclusion Interventional chemoembolization combined with Apatinib in the treatment of locally advanced hepatic cancer has decent efficacy and controllable adverse reactions,and it should be generalized in clinic.