FOLFOX4方案肝动脉灌注化疗联合125I粒子植入治疗原发性肝癌合并Ⅲ型门静脉癌栓患者的疗效与安全性研究  

Study on the efficacy and safety of FOLFOX4 regimen hepatic arterial infusion chemotherapy combined with 125I seed implantation in patients with primary liver cancer and type Ⅲ portal vein tumor thrombus

作　　者：蒋富强 杜鹏[1] 张嘉诚 Jiang Fuqiang;Du Peng;Zhang Jiacheng(Department of Interventional Medicine,the Sixth Medical Center of PLA General Hospital,Beijing 100000,China)

机构地区：[1]解放军总医院第六医学中心介入医学科,北京100000

出　　处：《中国医师进修杂志》2022年第5期415-421,共7页Chinese Journal of Postgraduates of Medicine

基　　金：解放军总医院第六医学中心创新培育基金(CXPY202008)。

摘　　要：目的比较FOLFOX4方案肝动脉灌注化疗(HAIC)联合125I粒子植入或伽马刀治疗原发性肝癌合并Ⅲ型门静脉癌栓(PVTT)患者的疗效和安全性。方法回顾性分析解放军总医院第六医学中心2016年1月至2018年6月116例原发性肝癌合并Ⅲ型PVTT患者的临床资料。其中,采用FOLFOX4方案HAIC联合PVTT内125I粒子植入治疗56例(观察组),FOLFOX4方案HAIC联合PVTT伽马刀治疗56例(对照组)。比较两组疗效、不良反应、肝功能、肿瘤标志物、生命质量、门静脉压力。随访至2021年6月,记录无进展生存(PFS)时间、总生存(OS)时间及1、3年生存率。结果观察组客观缓解率和疾病控制率明显高于对照组[21.43%(12/56)比7.14%(4/56)和50.00%(28/56)比30.36%(17/56)],差异有统计学意义(P<0.05)。观察组治疗后天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素、甲胎蛋白(AFP)、癌胚抗原(CEA)和肿瘤特异性生长因子(TSG)明显低于对照组[(58.24±7.16)U/L比(67.81±8.39)U/L、(56.39±5.42)U/L比(62.87±6.83)U/L、(21.21±4.32)μmol/L比(25.88±4.71)μmol/L、(32.98±6.15)μg/L比(45.06±7.24)μg/L、(2.39±0.22)μg/L比(3.17±0.26)μg/L和(57.81±5.67)kU/L比(66.19±5.45)kU/L],差异有统计学意义(P<0.01)。观察组治疗后生命质量核心量表(QLQ-C30)评分明显高于对照组[(68.13±6.95)分比(64.49±6.73)分],观察组治疗后门静脉压力明显低于对照组[(31.85±3.89)cmH2O(1 cmH2O=0.098 kPa)比(35.37±4.23)cmH2O],差异有统计学意义(P<0.01)。两组总不良反应发生率比较差异无统计学意义(P>0.05)。观察组失访2例,对照组失访3例;观察组PFS时间和OS时间明显长于对照组[(13.36±2.85)个月比(11.76±2.60)个月和(23.36±4.37)个月比(20.72±3.96)个月],差异有统计学意义(P<0.01);观察组1年生存率明显高于对照组[70.37%(38/54)比50.94%(27/53)],差异有统计学意义(P<0.05);两组3年生存率比较差异无统计学意义(P>0.05)。结论原发性肝癌合并Ⅲ型PVTT患�Objective To explore the efficacy and safety of FOLFOX4 regimen hepatic arterial infusion chemotherapy(HAIC)combined with 125I seed implantation or gamma knife in patients with primary liver cancer and typeⅢportal vein tumor thrombosis(PVTT).Methods The clinical data of 116 patients with primary liver cancer and typeⅢPVTT from January 2016 to June 2018 in the Sixth Medical Center of PLA General Hospital were retrospectively analyzed.Among them,56 patients were treated with FOLFOX4 regimen HAIC combined with 125I seed implantation in PVTT(observation group),and 56 patients were treated with FOLFOX4 regimen HAIC combined with gamma knife in PVTT(control group).The clinical efficacy,adverse reactions,liver function,tumor serum markers,quality of life and portal venous pressure were compared between 2 groups.The patients were followed up to June 2021,the progression-free survival(PFS)time,overall survival(OS)time and 1-,3-year survival rate were recorded.Results The objective response rate and disease control rate in observation group were significantly higher than those in control group:21.43%(12/56)vs.7.14%(4/56)and 50.00%(28/56)vs.30.36%(17/56),and there were statistical differences(P<0.05).The aspartate transaminase(AST),alanine transaminase(ALT),total bilirubin,alpha fetoprotein(AFP),carcinoembryonic antigen(CEA)and tumor supplied group of factor(TSG)after treatment in observation group were significantly lower than those in control group:(58.24±7.16)U/L vs.(67.81±8.39)U/L,(56.39±5.42)U/L vs.(62.87±6.83)U/L,(21.21±4.32)μmol/L vs.(25.88±4.71)μmol/L,(32.98±6.15)μg/L vs.(45.06±7.24)μg/L,(2.39±0.22)μg/L vs.(3.17±0.26)μg/L and(57.81±5.67)kU/L vs.(66.19±5.45)kU/L,and there were statistical differences(P<0.01).The quality of life questionnaire core-30(QLQ-C30)score after treatment in observation group was significantly higher than that in control group:(68.13±6.95)scores vs.(64.49±6.73)scores,the portal venous pressure after treatment in observation group was significantly lower than that in con

关 键 词：肝肿瘤 抗肿瘤联合化疗方案 碘放射性同位素 γ射线 门静脉癌栓 

分 类 号：R735.7[医药卫生—肿瘤]