雷替曲塞与表柔比星在不可切除原发性肝癌经导管肝动脉化疗栓塞术中的疗效比较  

Raltitrexed versus epirubicin in treatment of unresectable primary liver cancer patients with transarterial chemoembolization

作　　者：孙健 王甦[1] SUN Jian;WANG Su(Department of Gastroenterology,Subei People′s Hospital Affiliated to Clinical Medical College of Yangzhou University,Yangzhou,Jiangsu,225001;Department of Gastroenterology,Yangzhou Friendship Hospital,Yangzhou,Jiangsu,225001)

机构地区：[1]扬州大学临床医学院附属苏北人民医院消化内科,江苏扬州225001 [2]江苏省扬州友好医院消化内科,江苏扬州225001

出　　处：《实用临床医药杂志》2020年第11期87-91,96,共6页Journal of Clinical Medicine in Practice

摘　　要：目的比较雷替曲塞与表柔比星治疗不可切除原发性肝癌(PLC)行经导管肝动脉化疗栓塞术(TACE)患者的疗效及安全性。方法将114例不可切除PLC行TACE患者随机分为雷替曲塞组(n=58)和表柔比星组(n=56),2组均行2~5周期TACE治疗。雷替曲塞组采用雷替曲塞联合奥沙利铂治疗,表柔比星组采用表柔比星联合奥沙利铂治疗。比较2组临床疗效、甲胎蛋白(AFP)变化情况、远期疗效、不良反应及预后影响因素。结果2组患者均完成2次TACE治疗。雷替曲塞组患者客观有效率、疾病控制率均高于表柔比星组,但差异无统计学意义(P>0.05)。2次TACE术后4周复查发现,雷替曲塞组有24例AFP水平下降,表柔比星组有19例,2组差异无统计学意义(P>0.05)。随访6、12、24个月时,2组患者生存率均无显著差异(P>0.05);随访18个月时,雷替曲塞组患者生存率显著高于表柔比星组患者(P<0.05)。雷替曲塞组中位无进展生存期为12个月(95%CI为10.76~13.26),表柔比星组中位无进展生存期为9个月(95%CI为8.32~9.88),差异有统计学意义(P<0.05)。雷替曲塞组中位总生存期为18个月(95%CI为16.85~19.15),表柔比星组中位总生存期为16个月(95%CI为15.20~16.80),但差异无统计学意义(P>0.05)。雷替曲塞组术后不良反应发生率显著低于表柔比星组(P<0.05或P<0.01)。雷替曲塞组术后谷丙转氨酶(ALT)、谷草转氨酶(AST)水平显著低于表柔比星组(P<0.01)。预后影响因素分析结果显示,在治疗具有女性、乙肝、Child-Pugh分级B级、美国东部肿瘤协作组(ECOG)评分2分、肿瘤多发、肿瘤长径总和大于8 cm、有门脉癌栓、TNM分期Ⅲa期、术前AF P>400μg/mL等临床特征的患者时,采用雷替曲塞治疗获得的中位生存期显著长于采用表柔比星治疗的患者(P<0.05或P<0.01)。结论与表柔比星比较,采用雷替曲塞治疗不可切除PLC患者的临床疗效更好,不良反应更少,患者可以获得更长的中位生存期�Objective To compare the efficacy and safety of raltitrexed and epirubicin in the treatment of unresectable primary liver cancer(PLC)patients with transarterial chemoembolization(TACE).Methods Totally 114 unresectable PLC patients with TACE were randomly divided into raltitrexed group(n=58)and epirubicin group(n=56).Both groups were treated with TACE for 2 to 5 cycles.The patients in the raltitrexed group were treated with raltitrexed and oxaliplatin,and those in the epirubicin group were treated with epirubicin and oxaliplatin.The clinical efficacy,change of alpha fetoprotein(AFP),long-term efficacy,adverse reactions and influencing factors of prognosis were compared between the two groups.Results Patients in both groups completed 2 times of TACE treatment.The objective effective rate and disease control rate of raltitrexed group were higher than those of epirubicin group(P>0.05).At four weeks after 2 times of TACE,the decreased AFP level was observed in 24 cases in the raltitrexed group and 19 cases in the epirubicin group,and there was no significant difference between the two groups(P>0.05).At 6,12 and 24 months of follow-up,there were no significant differences in survival rates between the two groups(P>0.05).At 18 months of follow-up,the survival rate of the raltitrexed group was significantly higher than that of the epirubicin group(P<0.05).The median progression free survival of the raltitrexed group was 12 months(95%CI:10.76 to 13.26),which showed no significant difference when compared to 9 months of the epirubicin group(95%CI:8.32 to 9.88)(P>0.05).The median total survival of the raltitrexed group was 18 months(95%CI:16.85 to 19.15),which showed no significant difference when compared to 16 months of the epirubicin group(95%CI:15.20 to 16.80)(P>0.05).The incidence of adverse reactions in the raltitrexed group was significantly lower than that in the epirubicin group(P<0.05 or P<0.01).The levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in the raltitrexed group were significantl

关 键 词：原发性肝癌 经导管肝动脉化疗栓塞术 雷替曲塞 表柔比星 奥沙利铂 无进展生存期 总生存期 肝功能指标 

分 类 号：R735.7[医药卫生—肿瘤]