碘125粒子内放疗联合门静脉支架及TACE序贯索拉非尼治疗对原发性肝细胞癌合并门静脉主干癌栓患者生存的影响  

Effect of internal radiotherapy of iodine-125 seed implantation combined with portal vein stent and sequential TACE plus sorafenib on the survival of patients with hepatocellular carcinoma complicated with portal vein tumor thrombus

作　　者：张辉 杜松 牟玮 李中会 周暄琳 何闯 ZHANG Hui;DU Song;MOU Wei;LI Zhonghui;ZHOU Xuanlin;HE Chuang(Department of Vascular Surgery,the First Affiliated Hospital of Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院血管外科

出　　处：《癌症进展》2019年第23期2811-2814,共4页Oncology Progress

基　　金：军事医学与战创伤救治临床新技术计划（SWH2016JSTSYB-43）

摘　　要：目的探讨碘125粒子内放疗联合门静脉支架及经导管肝动脉化疗栓塞(TACE)序贯索拉非尼治疗原发性肝细胞癌合并门静脉主干癌栓患者的疗效及对血清肿瘤标志物水平的影响。方法根据治疗方法不同将56例原发性肝细胞癌合并门静脉主干癌栓患者分为A组(n=30)和B组(n=26)。A组患者接受TACE序贯索拉非尼治疗,B组患者接受碘125粒子内放疗联合门静脉支架及TACE序贯索拉非尼治疗。比较两组患者的近期疗效、治疗前后血清肿瘤标志物水平、3年生存情况及不良反应发生情况。结果B组患者的治疗总有效率为84.6%,高于A组患者的60.0%(P﹤0.05);治疗前,两组患者的血清甲胎蛋白(AFP)、谷氨酰转肽酶(GGT)、糖类抗原19-9(CA19-9)水平比较,差异均无统计学意义(P﹥0.05);治疗后,两组患者的血清AFP、GGT、CA19-9水平均明显低于本组治疗前,且B组患者的血清AFP、GGT、CA19-9水平均明显低于A组患者,差异均有统计学意义(P﹤0.01);A组患者的3年总生存率为29.63%,低于B组患者的58.33%(P﹤0.05);A组和B组患者的中位生存时间分别为17个月(95%CI:15.77~18.23)和29个月(95%CI:26.10~31.90),B组患者的生存结局明显优于A组(P﹤0.01);两组患者的不良反应总发生率比较,差异无统计学意义(P﹥0.05)。结论碘125粒子内放疗联合门静脉支架及TACE序贯索拉非尼治疗原发性肝细胞癌合并门静脉主干癌栓的近远期疗效均优于TACE序贯索拉非尼治疗,且可以有效降低血清肿瘤标志物水平。Objective To investigate the effect of internal radiotherapy of iodine-125 seed implantation combined with portal vein stent and sequential transarterial arterial chemoembolization(TACE)plus sorafenib as the treatment for patients with hepatocellular carcinoma(HCC)complicated with portal vein tumor thrombus and the impact on serum tumor markers.Method According to different therapies administered,56 patients with HCC combined with portal vein tumor thrombus were divided into group A(n=30)or group B(n=26),receiving sequential transarterial chemoembolization(TACE)plus sorafenib,or internal radiotherapy of iodine-125 seed implantation combined with portal vein stent in addition to the sequential TACE and sorafenib,respectively.The short-term efficacy,levels of serum tumor markers before and after treatment,3-year survival and incidence of adverse reactions were compared between the two groups of patients.Result After treatment,the overall response rate in group B was 84.6%,and was higher than the 60.0%in group A(P<0.05);before treatment,the levels of serum alpha-fetal protein(AFP),gamma-glutamyl ranspeptidase(GGT),and carbohydrate antigen 19-9(CA19-9)were similar between the two groups(P>0.05);while after treatment,the levels of serum AFP,GGT,and CA19-9 were significantly decreased in both groups,besides,the levels of serum AFP,GGT and CA19-9 in group B were lower compared to group A,and the differences were of statistical significance(P<0.01);the 3-year overall survival(OS)rate of patients in group A was 29.63%,and was lower than that in group B at 58.33%(P<0.05);the median survival time of patients in group A and group B was 17 months(95%CI:15.77-18.23)and 29 months(95%CI:26.10-31.90),respectively,indicating favorable survival outcome in group B patients as compared with those in group A(P<0.01);there was no statistical difference regarding the total incidence of adverse reactions in the two groups(P>0.05).Conclusion Internal radiotherapy of iodine-125 seed implantation combined with portal vein stent and sequenti

关 键 词：碘125粒子内放疗 门静脉支架 TACE 索拉非尼 原发性肝癌 门静脉主干癌栓 

分 类 号：R735.7[医药卫生—肿瘤]