TACE联合或不联合仑伐替尼及PD-1抑制剂治疗不可切除肝癌的疗效及对供血动脉影响  

TACE with or without Lenvatinib Plus PD⁃1 Inhibitors for Treating Unresectable Hepatocellular Carcinoma and Effect on Tumor Feeding Artery Diameter

作　　者：刘江勇 胡蓓 赵林 邱怀明 邹佳妮 杨博 黄文才 LIU Jiangyong;HU Bei;ZHAO Lin(Department of Radiography,General Hospital of Central Theater Command,Wuhan,Hubei Province 430070,P.R.China)

机构地区：[1]中部战区总医院放射诊断科,武汉430070

出　　处：《临床放射学杂志》2023年第4期665-671,共7页Journal of Clinical Radiology

摘　　要：目的探究经动脉化疗栓塞术(TACE)联合仑伐替尼及PD-1抑制剂(TA-LEN-IC)与TACE治疗不可切除肝癌的疗效及对肿瘤转移和供血动脉直径的影响。方法回顾性分析110例行TA-LEN-IC或TACE治疗的不可切除肝癌患者资料,比较两组患者肿瘤治疗反应,评估疾病进展时间(TTP)、新发转移或转移灶进展时间(TTM)、生存时间(OS)以及转移后生存时间(OSM),并测量肿瘤供血动脉直径。结果TA-LEN-IC组的疾病控制率显著高于TACE组(P=0.008),TA-LEN-IC组新发转移或转移灶进展患者显著低于TACE组(P<0.001)。TA-LEN-IC组的中位TTP(11.0个月)和OS(21.0个月)较TACE组(4.0个月和11.0个月)均显著延长(P=0.016和0.018)。TA-LEN-IC组的中位转移时间(30.0个月)显著长于TACE组(4.0个月)(P<0.001)。TA-LEN-IC组的中位OSM(12.0个月)较TACE组(6.0个月)显著延长(P<0.001)。TA-LEN-IC组术后4周的肿瘤供血动脉直径由术前的(4.0±1.3)mm减小为(3.3±1.3)mm(P=0.004),并且显著小于TACE组(P=0.042)。多因素分析显示术后供血动脉直径及治疗方式等为独立预测因子。患者接受TA-LEN-IC治疗的耐受性良好。结论TA-LEN-IC治疗不可切除肝癌能减小肿瘤供血动脉直径、抑制肿瘤进展和肿瘤转移、延长患者OSM及总体OS。Objective To investigate the effect of transarterial chemoembolization(TACE)with or without Lenvatinib plus PD⁃1 inhibitors(TA⁃LEN⁃IC)on unresectable hepatocellular carcinoma and tumor feeding artery diameter.Methods A total of 110 patients in our center were enrolled in this retrospective study(54 and 56 patients in the TA⁃LEN⁃IC and TA⁃CE groups,respectively).The tumor response,time to progression(TTP)or metastasis(TTM),overall survival(OS),and OS after metastasis(OSM)were evaluated.The diameter of tumor feeding artery was measured.Results The disease control rate in the TA⁃LEN⁃IC group was significantly higher than the TACE group(P=0.008),while the metastasis was significantly lower than the TACE group(P<0.001).The median TTP(11.0 months)and OS(21.0 months)were also significantly longer than the TACE group(4.0 and 11.0 months,respectively)(P=0.016 and 0.018,respectively).The median time to metastasis in the TA⁃LEN⁃IC group was 30.0 months,significantly prolonged than the 4.0 months in the TA⁃CE group(P<0.001).The median OSM was 12.0 and 6.0 months in the TA⁃LEN⁃IC and TACE group(P<0.001),re⁃spectively.The tumor feeding artery diameter in the TA⁃LEN⁃IC group was(4.0±1.3)mm pre⁃treatment,and reduced to(3.3±1.3)mm post⁃treatment(P=0.004),which significantly smaller than the TACE group(P=0.042).The multiva⁃riable analysis indicated that the post⁃treatment tumor artery diameter was an independent predictor for OS.TA⁃LEN⁃IC treatment was safety.Conclusion TA⁃LEN⁃IC treatment could reduce tumor feeding artery diameter,inhibit tumor pro⁃gression and metastasis,prolong overall survival and survival after metastasis.

关 键 词：肝癌 经动脉化疗栓塞术 仑伐替尼 PD-1抑制剂 肿瘤供血动脉 转移 

分 类 号：R735.7[医药卫生—肿瘤]