125I腔内照射联合仑伐替尼治疗进展期肝外胆管癌的效果和安全性分析  

Efficacy and safety of 125I intraluminal irradiation combined with lenvatinib in treatment of progressive extrahepatic cholangiocarcinoma

作　　者：朱兴书 陈鹏飞[1] 张萌帆 李方正[1] 陈金威 张文广[1] 段旭华[1] 任建庄[1] 韩新巍[1] ZHU Xingshu;CHEN Pengfei;ZHANG Mengfan;LI Fangzheng;CHEN Jinwei;ZHANG Wenguang;DUAN Xuhua;REN Jianzhuang;HAN Xinwei(Department of Interventional Radiology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院介入科,郑州450052

出　　处：《临床肝胆病杂志》2023年第10期2406-2412,共7页Journal of Clinical Hepatology

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190155);河南省医学科技攻关计划(省部共建)项目(SBGJ202002072);河南省自然科学基金项目(202300410461)。

摘　　要：目的 探讨125I腔内照射联合仑伐替尼治疗进展期肝外胆管癌的有效性和安全性。方法 回顾性纳入2018年1月—2021年11月于郑州大学第一附属医院介入科就诊的进展期肝外胆管癌患者25例。根据治疗方式分为两组,125I腔内照射联合仑伐替尼组患者13例(联合组)和单纯125I腔内照射组12例(对照组)。记录技术成功率、肝功能变化、支架通畅情况、生存期和不良事件的发生情况。正态分布的计量资料两组间比较采用成组t检验,偏态分布的计量资料两组比较采用Wilcoxon秩和检验,计数资料组间比较采用Fisher确切概率法。采用Kaplan-Meier和Log-rank检验评估生存期和支架通畅情况。结果 两组所有患者均成功植入胆道支架和125I粒子,技术成功率100%。治疗1个月后,两组患者血清TBil、DBil、ALT和AST显著改善,与治疗前比较差异均有统计学意义(P值均<0.05)。对照组和联合组的中位支架通畅期分别为7.0和9.5个月,差异有统计学意义(P=0.022),中位生存期分别为11.5和15.6个月,差异有统计学意义(P=0.008)。治疗过程中联合组未出现不可耐受的不良事件。结论125I腔内照射联合仑伐替尼对比单纯125I腔内照射治疗进展期肝外胆管癌具有更好的疗效,是一种安全、有效的治疗方案。Objective To investigate the efficacy and safety of 125I intraluminal irradiation combined with lenvatinib in the treatment of progressive extrahepatic cholangiocarcinoma.Methods A retrospective analysis was performed for 25 patients with progressive extrahepatic cholangiocarcinoma who attended Department of Interventional Radiology,The First Affiliated Hospital of Zhengzhou University,from January 2018 to November 2021,and according to the treatment modality,they were divided into combination group with 13 patients(125I intraluminal irradiation combined with lenvatinib)and control group(125I intraluminal irradiation alone).The two groups were compared in terms of technical success rates,changes in liver function,stent patency,survival time,and incidence rates of adverse events.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Wilcoxon rank-sum test was used for comparison of continuous data with skewed distribution between two groups;the Fisher’s exact test was used for comparison of categorical data between groups. The Kaplan-Meier method and the log-rank test were used to evaluate survival time and stent patency. Results All patients had successful implantation of biliary stents and 125I particles, with a technical success rate of 100%. After 1 month of treatment, both groups had significant improvements in the serum levels of total bilirubin, direct bilirubin, alanine aminotransferase, and aspartate aminotransferase (all P<0.05). There were significant differences between the control group and the combination group in the duration of stent patency (7.0 months vs 9.5 months, P=0.022) and median survival time (11.5 months vs 15.6 months, P=0.008). There were no intolerable adverse events in the combination group during treatment. Conclusion Compared with 125I intraluminal irradiation alone, 125I intraluminal irradiation combined with lenvatinib has better efficacy and is a safe and effective treatment regimen for progressive extrahepatic

关 键 词：胆管上皮癌 碘放射性同位素 仑伐替尼 放射学 介入性 

分 类 号：R735.8[医药卫生—肿瘤]