替吉奥联合阿帕替尼辅助治疗TACE术后原发性肝癌的临床观察及cfDNA与疗效的相关性  

Clinical observation of seggio combined with apatinib in the treatment of primary liver cancer after TACE and the correlation between cfDNA and efficacy

作　　者：薛晨祺 徐春阳 姚煜 王涌臻 戴峰[1] 陈刚[1] XUE Chenqi;XU Chunyang;YAO Yu;WANG Yongzhen;DAI Feng;CHEN Gang(Department of Interventional Radiotherapy,Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine(Nanjing Second Hospital),Nanjing 210003,China)

机构地区：[1]南京中医药大学附属南京医院(南京市第二医院)介入放射科,南京210003

出　　处：《临床与病理杂志》2022年第11期2689-2698,共10页Journal of Clinical and Pathological Research

摘　　要：目的:观察替吉奥(seggio)联合阿帕替尼辅助治疗经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)术后原发性肝癌(primar ylivercancer,PLC)的临床疗效,探讨血液游离DNA(cell-free DNA,cfDNA)水平与疗效的相关性。方法:纳入2014年2月至2015年5月于南京中医药大学附属南京医院TACE术后PLC患者60例,其中30例经替吉奥联合阿帕替尼治疗的患者为研究组,30例经替吉奥治疗的患者为对照组。记录患者治疗后的不良反应(adverse reaction,ADR)发生频次,评价不同组别近期疗效,同时比较不同组别、不同疗效的cfDNA水平差异。进一步按cfDNA表达水平把PLC患者分成高表达组与低表达组,对患者进行长期随访,比较他们不同时间段生存率的差异、中位总生存时间(median overall survival,MOS)和无进展生存期(progression-free survival,PFS)。Cox单因素和多因素分析影响TACE术后PLC患者生存率的因素。结果:两组患者的ADR发生频次构成比相似(P>0.05)。研究组的总有效率(overall responserate,ORR)为53.33%,显著高于对照组的26.67%(P<0.05)。长期随访结果显示:研究组的MOS较对照组长,且5年生存率高于对照组(P<0.05)。cfDNA高表达组患者5年生存率较cfDNA低表达组高(P<0.05),PFS较cfDNA低表达组长(P<0.05)。Cox多因素分析结果显示:巴塞罗那临床肝癌(Barcelona Clinic Liver Cancer,BCLC)分级与cfDNA水平是影响晚期PLC患者治疗后生存的独立危险因素。结论:替吉奥联合阿帕替尼辅助治疗TACE术后PLC患者的疗效优于替吉奥单药治疗,ADR可耐受,可提高患者的生存率,且检测cfDNA水平对监测PLC患者疗效评价具有一定价值。Objective:To observe the clinical efficacy of seggio combined with apatinib in the adjuvant treatment of primary liver cancer(PLC)after transcatheter arterial chemoembolization(TACE),and investigate the correlation between cell-free DNA(cf DNA)level and efficacy.Methods:A total of 60 patients with PLC after TACE in Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine from February 2014 to May 2015 were selected,including 30 patients treated with seggio combined with apatinib as a test group and 30 patients treated with seggio as a control group.After the treatment,the frequency of adverse reaction(ADR)was recorded,and the short-term efficacy of different groups was evaluated.At the same time,the differences in cf DNA levels of different groups and different efficacy were compared.PLC patients were further divided into a high expression group and a low expression group according to cf DNA expression level,and long-term follow-up of patients was performed to compare the difference in survival rate,median overall survival(MOS)time,and progression-free survival(PFS)time in different time periods.Cox univariate and multivariate analysis was used to analyse the factors affecting the survival rate of PLC patients after TACE.Results:The frequency ratio of ADR in the 2 groups was similar(P>0.05).The ORR of the test group was 53.33%,significantly higher than that of the control group(26.67%)(P<0.05).Long-term follow-up results showed that the MOS in the test group was longer than that in the control group.The 5-year survival rate of patients in the cf DNA high expression group was higher than that in the cf DNA low expression group(P<0.05),and the PFS was longer than that in the cf DNA low expression group(P<0.05).Cox multivariate analysis showed that Barcelona Clinic Liver Cancer(BCLC)stage and cf DNA concentration were independent risk factors that affected the prognosis of patients with advanced PLC.Conclusion:Seggio combined with apatinib adjuvant treatment of PLC patients after TACE is better than seg

关 键 词：原发性肝癌 血液游离DNA 经导管肝动脉化疗栓塞 替吉奥 阿帕替尼 疗效评估 

分 类 号：R735.7[医药卫生—肿瘤]