索拉非尼治疗肝细胞癌患者的不良反应及其对预后的影响  

Sorafenib Treatment-related Adverse Events on Prognosis in Patients with Hepatocellular Carcinomas

作　　者：安林静[1] 郝丽燕[1] 张昕[1] 张丽娜[1] 李因茵[1] 陆荫英[1] 王春平[1] 曲建慧[1] 杨永平[1] 

机构地区：[1]解放军第302医院肝脏肿瘤诊疗与研究中心,北京100039

出　　处：《解放军护理杂志》2011年第17期8-11,共4页Nursing Journal of Chinese People's Liberation Army

基　　金：国家重大专项基金资助项目(2008ZX10002-018)

摘　　要：目的了解索拉非尼治疗进展期肝细胞癌(hepatocellular carcinoma,HCC)患者相关不良反应的发生率及其对预后的影响。方法依据美国国立癌症研究所毒性判定标准观察索拉非尼治疗110例进展期HCC患者相关不良反应;Kaplan-Meier曲线分析相关不良反应对进展期HCC预后的影响。结果索拉非尼相关不良反应发生情况:手足综合征、皮疹、高血压、脱发、乏力、消瘦、腹泻、肝脏毒性和血液系统相关毒性的发生率分别为65.5%、63.6%、54.5%、50.9%、47.3%、45.5%、41.8%、40.0%和34.5%;3或4级相关不良反应为16.4%,常见3级不良反应是手足综合征(15.5%)、肝脏毒性(8.2%)、腹泻(4.5%)、高血压(3.6%)和上消化道出血(2.7%),4级不良反应是肝脏毒性(6.4%)、上消化道出血(4.5%)、白细胞减少症(3.6%)、贫血(1.8%)和腹泻(1.8%)。患者中位肿瘤进展时间(time to progression,TTP)延长;进展期HCC疾病控制率(diease control rate,DCR)低与乏力、体质量减轻和肝脏毒性有关;生存期(overall survival,OS)和TTP短与乏力、体质量减轻、恶心、腹痛和肝脏毒性相关。结论索拉非尼常见不良反应是手足综合征和皮疹,两者是索拉非尼起效的标志;乏力、体质量减轻及肝脏毒性明显者DCR低;乏力、体质量减轻、恶心、腹痛和肝脏毒性明显者中位OS和TTP短。Objective To investigate the incidence of Sorafenib treatment-related adverse events in the patients with advanced hepatocellular carcinoma（HCC） and its influence on the prognosis.Methods The baseline characteristics and outcomes of 110 patients with advanced HCC treated by sorafenib were collected.The treatment-related adverse events were determined according to the National Cancer Institute Common Toxicity Criteria.Kaplan-Meier method were used to determine the influence of the adverse events on the prognosis of HCC.Results Sorafenib treatment-related adverse events were listed as follows：hand-foot skin reaction（HFSR）（65.5%）,rash（63.6%）,hypertension（54.5%）,alopecia（50.9%）,fatigue（47.3%）,weightloss（45.5%）,diarrhea（41.8%） and liver toxicity（40%）,and hematological toxicities 38（34.5%）.The grade 3 or 4 toxicity accounted for 16.4%.The commonest grade 3 toxicities were HFSR（15.5%）,liver toxicity（8.2%）,diarrhea（4.5%）,hypertension（3.6%） and hemorrhage（2.7%）.The most commonly grade 4 toxicities included liver toxicity（6.4%）,hemorrhage（4.5%）,leucopenia（3.6%）,anemia（1.8%） and diarrhea（1.8%）.The patients having longer time-to-progress（TTP）.Fatigue,weightloss and liver toxicity were related to disease-control-rate（DCR） in advanced HCC patients.Fatigue,weightloss,nausea,abdominal pain and liver toxicity were associated with shorter TTP and overall survival（OS）.Conclusion HFSR and rash were the most commonly encountered toxicities which may be signs for longer TTP and better prognosis in advanced HCC patiens treated by sorafenib.Fatigue,weightloss and liver toxicity were the adverse factors for patients with poor DCR.The adverse factors for patients with the short TTP and median OS include fatigue,weightloss,nausea,abdominal pain and liver toxicity.

关 键 词：索拉非尼 进展期肝细胞癌 临床护理 生存期 

分 类 号：R735.7[医药卫生—肿瘤]