肝动脉灌注化疗联合靶向免疫序贯^(125)I粒子植入治疗肝细胞癌伴门静脉癌栓的疗效分析  

Efficacy analysis of hepatic arterial infusion chemotherapy combined with targeted and immune therapy followed by^(125)I seeds implantation in the treatment of hepatocellular carcinoma with portal vain tumor thrombus

作　　者：王猛[1] 周志刚[1] 路太英[2] 杜可朴[1] 李帅[1] 高飞[1] 李亚丹[1] 高梦宇 Wang Meng;Zhou Zhigang;Lu Taiying;Du Kepu;Li Shuai;Gao Fei;Li Yadan;Gao Mengyu(Department of Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Oncology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院放射科,郑州450052 [2]郑州大学第一附属医院肿瘤科,郑州450052

出　　处：《中华医学杂志》2024年第4期290-296,共7页National Medical Journal of China

摘　　要：目的探讨肝动脉灌注化疗(HAIC)联合靶向免疫序贯门静脉癌栓(PVTT)内^(125)I粒子植入治疗肝细胞癌(HCC)伴PVTT的安全性和有效性。方法回顾性分析郑州大学第一附属医院2020年10月至2022年10月21例[男11例,女10例,年龄:34~73(52.6±13.7)岁]接受HAIC联合靶向免疫序贯PVTT内^(125)I粒子植入治疗的伴PVTT的HCC患者临床资料,随访至2023年1月,根据改良版实体瘤疗效评价标准(mRECIST)进行疗效评价。记录疾病无进展生存期(PFS)、生存期(OS)及治疗后3、6、12、18个月疾病无进展生存率(PFSR)、生存率(OSR)及PVTT控制率。观察肝功能、甲胎蛋白、凝血功能变化和不良事件发生情况。结果每例患者接受2~7(3.3±1.2)周期HAIC治疗,每例患者植入10~37(16.6±6.7)枚^(125)I粒子。中位随访时间15(5~25)个月。随访期间15例患者出现进展,6例患者死亡。中位PFS(mPFS)为11个月,治疗后3、6、12和18个月PFSR分别是90.5%(19/21)、71.4%(15/21)、42.9%(9/21)和23.8%(5/21),3、6、12、和18个月OSR分别是100%(21/21)、100%(21/21)、81.0%(17/21)和62.0%(13/21)。3、6、12个月时PVTT控制率分别是90.5%(19/21)、90.5%(19/21)和61.9%(13/21)。总体疗效评价完全缓解(CR)率0,部分缓解(PR)率47.6%(10/21),疾病稳定(SD)率38.1%(8/21),疾病进展(PD)率14.3%(3/21)。总的治疗相关不良反应发生率100%,有4例出现Ⅲ级不良反应;其余均为Ⅰ~Ⅱ级不良反应。手术并发症方面,11例(52.4%)出现右上腹部疼痛,5例(23.8%)出现发热,3例(14.3%)出现肝包膜下出血。结论肝动脉灌注化疗联合靶向免疫序贯PVTT内^(125)I粒子植入是治疗HCC伴PVTT安全有效的方法。Objective To investigate the safety and efficacy of Hepatic Arterial Infusion Chemotherapy(HAIC)combined with targeted and immune therapy followed by^(125)I seeds implantation in portal vain tumor thrombus(PVTT)in the treatment of hepatocellular carcinoma(HCC)with PVTT.Methods A retrospective study was performed on the clinical data of 21 patients[(11 men,10 women)aged 34-73(52.6±13.7)years]with HCC with PVTT in The First Affiliated Hospital of Zhengzhou University from October 2020 to October 2022,all of them were treated with HAIC plus targeted and immune therapy,and^(125)I seeds implanted into PVTT.The patients were followed up to January 2023,the efficacy was evaluated according to the modified version of the solid tumor efficacy evaluation criteria(mRECIST).The progression-free survival(PFS)rate,overall survival(OS)rate and portal tumor thrombus control rate at 3,6,12 and 18 months after treatment were recorded,and PFS and OS time were followed up.The changes of liver function,AFP,coagulation function and adverse events were observed.Results Each patient received 2 to 7(mean:3.3±1.2)cycles of HAIC.10-37 seeds(mean:16.6±6.7)were implanted per patients.The median follow-up time was 15(range from 5 to 25)months.During the follow-up time,15 patients showed progression and 6 patients died,and the PFS rates at 3,6,12,and 18 months after treatment were 90.5%,71.4%,42.9%,and 23.8%,respectively,and at 3,6,12,and 18-month OS rates were 100%,100%,81.0%,and 61.9%,respectively.The PVTT control rates at 3,6,and 12 months were 90.5%,90.5%,and 62.5%,respectively.Overall efficacy evaluation of CR rate 0,PR rate 47.6%(10/21),SD rate 38.1%(8/21),and PD rate 14.3%(3/21).The total incidence of treatment-related adverse events was 100%.Grade 3 treatment related adverse events were observed for 4 cases,the rest wereⅠtoⅡadverse events.Right upper abdominal pain,fever and hemorrhage in liver capsule related to the procedures were observed in 11(52.4%),5(23.8%)and 3(14.3)patients,respectively.Conclusion HAIC combined with targ

关 键 词：门静脉癌栓 肝动脉灌注化疗 ^(125)I粒子 肝细胞癌 

分 类 号：R735.7[医药卫生—肿瘤]