TACE联合贝伐珠单抗治疗不可切除结直肠癌肝转移的临床研究

Clinical Study of TACE Combined with Bevacizumab Chemotherapy in the Treatment of Unresectable Colorectal Carcinoma with Hepatic Metastases

目的评价经导管动脉内化疗栓塞(TACE)联合贝伐单抗治疗不可切除结直肠肝转移癌的临床疗效。方法将120例不可切除结直肠肝转移癌的患者随机分为TACE治疗组(40例)、贝伐单抗治疗组(40例)、TACE联合贝伐单抗治疗组(40例),观察这三组患者肿瘤大小、免疫功能、血清肿瘤标志物及患者生存情况等指标。结果 TACE联合贝伐单抗治疗后,T淋巴细胞CD4+、CD8+细胞数CD4+、CD8+较治疗前显著升高(P<0.05),CD4+/CD8+的差异均无统计学意义;联合治疗中CEA、CA 199水平显著下降(P<0.05),肿瘤生长明显受抑制,坏死范围较另两组大;且TACE联合贝伐单抗组患者3年生存率显著高于TACE组、贝伐单抗组(P<0.05),TACE组与贝伐单抗组3年生存率比较差异无统计学意义。40例TACE联合贝伐单抗患者完全缓解0例、部分缓解16例、稳定20例、肿瘤进展4例,中位生存期为27.3个月,比二者单独治疗时控制肿瘤发展效果更佳。结论 TACE联合贝伐单抗治疗不能手术切除的结直肠癌肝转移时,相比较于TACE或贝伐单抗单独治疗更能有效抑制肝转移瘤的生长,延长患者生存时间,具有一定的临床应用价值。

Objective To evaluate the clinical efficacy of transcatheter arterial chemoembolization( TACE) combined with bevacizumab in the treatment of unresectable colorectal carcinoma with hepatic metastases. Methods 120 cases of unresectable colorectal carcinoma with hepatic metastases were randomly divided into TACE group( n = 40),bevacizumab group( n =40),TACE and bevacizumab combination group( n = 40). Tumor size,immune function,serum tumor markers and survival functions after treatment were observed in the 3 groups. Results In the combination group,after the treatment with TACE and bevacizumab,CD4 + and CD8 + increased significantly( P < 0. 05),but CD4 + / CD8 + had no significant difference. In the combined treatment group,CEA、CA 199 decreased significantly( P < 0. 05),the growth of tumor size were significantly suppressed,and necrosis area appeared larger than the other 2 groups. Moreover,the 3-year survival rate of the combination group was significantly higher than TACE group and bevacizumab group( P < 0. 05). There was 0 case of complete remission,16 cases of partial remission,20 cases of stability and 4 cases of tumor progression in 40 patients who undergone combined treatment. The median survival time was 27. 3 months. The combination treatment could control the progress of tumor growth. Conclusion For unresectable colorectal carcinoma with hepatic metastases,TACE combined with bevacizumab is more effective than conventional TACE or bevacizumad only,it should be recommended in clinical practice.