DEB-TACE联合MWA及阿帕替尼治疗巨块型肝癌的临床疗效  

DEB-TACE combined with MWA and apatinib for the treatment of huge hepatocellular carcinoma

作　　者：冯超凡 胡继红[1] 张学贤 游占亮 王飞[1] 赵卫[1] 万程[1] 熊峰 FENG Chaofan;HU Jihong;ZHANG Xuexian;YOU Zhanliang;WANG Fei;ZHAO Wei;WAN Cheng;XIONG Feng(Department of Medical Imaging,First Affiliated Hospital of Kunming Medical University,Kunming,Yunnan Province 650032,China)

机构地区：[1]昆明医科大学第一附属医院医学影像中心,650032

出　　处：《介入放射学杂志》2022年第3期254-258,共5页Journal of Interventional Radiology

摘　　要：目的探讨DEB-TACE联合MWA及阿帕替尼治疗巨块型肝癌的临床疗效。方法回顾性分析昆明医科大学第一附属医院2017年7月至2019年7月采用载药微球(DEB)-TACE联合MWA及阿帕替尼治疗的23例巨块型肝癌患者的临床资料,根据改良实体肿瘤评价标准评估临床疗效,评估DEBTACE及消融术后并发症及口服阿帕替尼的不良反应,分析影响患者预后的因素。结果患者接受治疗后6、12个月,总生存率(OS)分别为91.3%、78.3%;在1、3、6、12个月,患者客观缓解率(ORR)分别为56.5%、87.0%、78.2%、87.0%,其中位无进展生存期(mPFS)为14.0个月,mOS为27.0个月。DEB-TACE术后不良反应主要为腹痛、恶心、呕吐、发热及肝功能损伤等,消融术后并发症主要为气胸、肝包膜下出血、疼痛等,阿帕替尼不良反应主要为手足综合征、继发性高血压、蛋白尿、脱发及皮肤色素沉着症等。所有并发症均通过支持治疗得到缓解,所有不良反应均未超过3级,且通过支持治疗或调整药量得到控制。结论DEB-TACE联合MWA及阿帕替尼对巨块型中晚期肝癌具有明显疗效。Objective To investigate the clinical efficacy of drug-eluting beads transcatheter arterial chemoembolization(DEB-TACE)combined with microwave ablation(MWA)and apatinib in the treatment of huge(tumor length>10 cm)hepatocellular carcinoma(HCC).Methods The clinical date of a total of 23 patients with huge HCC,who received DEB-TACE combined with MWA and apatinib at the First Affiliated Hospital of Kunming Medical University of China during the period from July 2017 to July 2019,were retrospectively analyzed.Based on the modified Response Evaluation Criteria in Solid Tumor(mRECIST)the clinical curative effect was evaluated,and the postoperative complications of DEB-TACE and MWA as well as the side effects of oral apatinib were also assessed.The factors affecting the prognosis of patients were analyzed.Results The postoperative 6-and 12-month overall survival(OS)rates were 91.3%and 78.3%respectively;the postoperative1-,3-,6-and 12-month objective remission rates(ORR)were 56.5%,87.0%,78.2%and 87.0%respectively.The median progression-free survival(mPFS)was 14.0 months,and the median OS(mOS)was 27.0 months.The postoperative adverse reactions of DEB-TACE mainly included abdominal pain,nausea,vomiting,fever,liver function damage,etc.The main complications of MWA were pneumothorax,subcapsular hemorrhage of liver,pain,etc.The main side effects of apatinib were hand-foot syndrome,secondary hypertension,proteinuria,alopecia,skin pigmentation,etc.All complications were alleviated after symptomatic treatment.None of the adverse reactions exceeded grade 3,and all the adverse events could be controlled by symptomatic supportive treatment or by adjusting the dose of apatinib.Conclusion For the treatment of huge advanced HCC,DEB-TACE combined with MWA and apatinib has remarkable curative effect.(J Intervent Radiol,2022,31:254-258)

关 键 词：巨块型肝癌 载药微球 微波消融 阿帕替尼 

分 类 号：R735[医药卫生—肿瘤]