奥沙利铂介入治疗早中期原发性肝癌的疗效分析

Curative effect analysis of transcatheter arterial chemoembolization by using oxaliplatin for early and middle stage hepatocellular carcinoma

目的探讨奥沙利铂介入治疗早中期原发性肝癌的有效性并分析疾病无进展生存期(PFS)。方法回顾性分析于2004年11月1日—2011年4月30日接受奥沙利铂介入治疗的48例早中期原发性肝癌患者的临床资料。该方案采用奥沙利铂粉剂(150 mg)与适量超液化碘油(3～10 mL)混合对目标病灶经肝动脉化疗栓塞(TACE)。每6～8周通过CT和/或MRI检查了解目标病灶的活性情况,无活性病灶者随访观察,有活性灶者再行此方案治疗,直至截止日期2015年12月31日,或单用TACE治疗不可控制病情时,按照mRECIST标准客观评价其疗效,并记录疾病PFS。运用SPSS19.0统计软件,采用Kaplan-Meier法(乘积极限法)进行分析。结果截止到随访结束日期,48例患者均可有效评价,中位PFS为20.0个月,95%CI为5.3～34.7个月。CR 16例,PR 25例,SD 3例,PD 4例。术后31例(64.6%)患者出现不良反应,表现为腹痛、恶心、呕吐、发热、肝功能受损、骨髓抑制等,多为Ⅰ～Ⅱ度,无治疗相关性死亡,所有不良反应经对症治疗后恢复正常。结论奥沙利铂介入治疗早中期原发性肝癌的疗效确切,可明显延长PFS,改善患者生活质量。

Objective To investigate the curative efficacy of transcatheter arterial chemoembolization(TACE)by using oxaliplatin for the treatment of early and middle stage hepatocellular carcinoma(HCC),and to analyze its effect on the progression-free survival(PFS).Methods The clinical data of 48 patients with early and middle stage HCC,who received TACE by using oxaliplatin at authors’hospital during the period from January 1,2004 to April 30,2011,were retrospectively analyzed.The therapeutic regimen was as follows:oxaliplatin powder(150 mg)was mixed with suitable amount of super-liquefied Lipiodol(3-10 mL)and TACE with the mixture was conducted for the target lesions.After TACE,examination with CT and/or MRI was performed every 6 weeks to observe the activity of the target lesions.Continued follow-up observation was implemented for patients who showed no active lesions,while for patients who had active lesions this therapeutic regimen was repeated till December 31,2015 or when the patient’s condition was uncontrollable by pure TACE therapy.The objective curative effect was evaluated with mRECIST standard,and the PFS was documented.Using SPSS 19.0 statistical software,the statistical analysis of the data was conducted with Kaplan-Meier method(product limit method).Results At the end day of follow-up period,the curative effect of all the 48 patients could be evaluated.The median PFS was 20.0 months(95%CI:5.3-34.7 months).Complete remission(CR)was obtained in 16 patients,partial remission(PR)in 25 patients,stable disease(SD)in 3 patients,and progression disease(PD)in 4 patients.Postoperative adverse reactions occurred in 31 patients(64.6%),including abdominal pain,nausea,vomiting,fever,impaired liver functions,bone marrow suppression,etc.,the severity of which wereⅠ-Ⅱdegree in most cases.No treatment-related death occurred.All adverse reactions returned to normal after symptomatic treatment.Conclusion For the treatment of early and middle stage HCC,TACE with oxaliplatin has reliable curative effect.This therapy can remarkably prolong PFS and improve the quality of life of patients.