肝动脉灌注化疗联合PD-1抗体及仑伐替尼治疗晚期肝癌合并门静脉癌栓的临床研究  

A clinical study of hepatic artery infusion chemotherapy combined with PD-1 antibody and lenvatinib in the treatment of advanced liver cancer complicated with portal vein tumor thrombus

作　　者：贾浪 李有赞 朱世凯[2] 陈凯[2] 赵冀[2] 唐几超 杨洪吉 邓绍平[1,2] JIA Lang;LI You-zan;ZHU Shi-kai;CHEN Kai;ZHAO Ji;TANG Ji-chao;YANG Hong-ji;DENG Shao-ping(School of Clinical Medicine,Southwest Medical University,Luzhou 646000,China;Multi-Organ Transplant Center,Sichuan Academy of Medical Sciences&Sichuan Provincial People′s Hospital,Chengdu 610072,China;Department of Hepatobiliary Surgery,Chengdu Third People′s Hospital,Chengdu 610043,China)

机构地区：[1]西南医科大学临床医学院,四川泸州646000 [2]四川省医学科学院·四川省人民医院器官移植中心,四川成都610072 [3]成都市第三人民医院肝胆外科,四川成都610043

出　　处：《实用医院临床杂志》2022年第5期163-167,共5页Practical Journal of Clinical Medicine

基　　金：四川省卫生健康委员会科研基金资助项目(编号:16PJ444)。

摘　　要：目的 比较肝动脉灌注化疗(HAIC)联合程序性死亡受体1(PD-1)抗体及仑伐替尼方案与PD-1抗体联合仑伐替尼方案在治疗晚期肝癌合并门静脉癌栓(PVTT)的临床疗效和安全性。方法 2018年8月至2022年3月四川省人民医院经病理活检或影像学诊断晚期原发性肝癌合并PVTT的患者50例,其中25例采用HAIC联合PD-1抗体及仑伐替尼方案治疗(试验组),25例采用PD-1抗体联合仑伐替尼方案治疗(对照组),观察两组治疗过程的不良反应,并6~8周复查评估一次。结果 试验组在肿瘤客观缓解率(ORR)、疾病控制率(DCR)、中位无疾病进展期(mPFS)、中位总生存期(mOS)等方面均优于对照组(P<0.05)。Cox回归分析得出ECOG PS评分、AFP范围以及治疗方案的选择均为影响患者总生存期(OS)的独立预后因素(P<0.05)。所有患者治疗过程均未出现5级药物不良反应,均未进行药物减量,其余不良反应予以对症处理后缓解。结论 HAIC联合PD-1抗体及仑伐替尼治疗晚期肝癌合并PVTT的临床效果优于PD-1抗体联合仑伐替尼方案,能明显延长患者的生存时间,且不良反应可控,安全性好。Objective To compare the clinical efficacy and safety between the hepatic artery infusion chemotherapy(HAIC) combined with programmed death receptor 1(PD-1) antibody and lenvatinib regimen and the PD-1 antibody combined with lenvatinib regimen in the treatment of advanced hepatocellular carcinoma complicated with portal vein tumor thrombus(PVTT).Methods From August 2018 to March 2022, 50 patients with advanced primary liver cancer complicated with PVTT were diagnosed by pathological biopsy or imaging in Sichuan Provincial People′s Hospital. Among them, 25 patients were treated with HAIC combined with PD-1 antibody and lenvatinib regimen(experimental group), and 25 patients were treated with PD-1 antibody combined with lenvatinib regimen(control group). Adverse reactions during the treatment in the two groups were observed and re-evaluated once every 6-8 weeks.Results The experimental group was superior to the control group in tumor objective response rate(ORR), disease control rate(DCR), median progression-free survival(mPFS), and median overall survival(mOS)(P<0.05). Cox regression analysis showed that ECOG PS score, AFP range and choice of treatment regimen were independent prognostic factors for overall survival(OS)(P<0.05). There were no grade 5 adverse drug reactions in all patients during treatment, and no drug dosage reduction was performed. The rest adverse reactions were relieved after symptomatic treatment.Conclusion HAIC combined with PD-1 antibody and lenvatinib has more advantages than PD-1 antibody combined with lenvatinib regimen in the treatment of patients with advanced liver cancer complicated with PVTT. It can significantly prolong the survival time of the patients. The adverse reactions are controllable with good safety.

关 键 词：原发性肝癌 门静脉癌栓 肝动脉灌注化疗 PD-1抗体 仑伐替尼 

分 类 号：R735.7[医药卫生—肿瘤]