mFOLFOX7方案全身化疗联合卡瑞利珠单克隆抗体和阿帕替尼治疗肝细胞癌合并Vp4型门静脉癌栓的疗效  

Efficacy of mFOLFOX7 regimen systemic chemotherapy combined with camrelizumab and apatinib for hepatocellular carcinoma with Vp4 portal vain tumor thrombus

作　　者：彭林辉[1] 陈涛[1] 徐云修修 王捷[1] 陈捷[1] 李永[2] 黄拼搏[1] 钟国平 陈茜 叶聪婷 陈亚进[1] Peng Linhui;Chen Tao;Xu Yunxiuxiu;Wang Jie;Chen Jie;Li Yong;Huang Pinbo;Zhong Guoping;Chen Xi;Ye Congting;Chen Yajin(Department of Hepatobiliary Surgery,Sun Yat‐sen Memorial Hospital,Sun Yat‐sen University,Guangzhou 510120,China;Department of Radiology,Sun Yat‐sen Memorial Hospital,Sun Yat‐sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院肝胆外科,广州510120 [2]中山大学孙逸仙纪念医院放射科,广州510120

出　　处：《中华消化外科杂志》2024年第2期265-271,共7页Chinese Journal of Digestive Surgery

基　　金：国家卫生健康委人才交流服务中心项目(RCLX2315049);广东省消化系统疾病临床医学研究中心项目(2020B1111170004)。

摘　　要：目的探讨mFOLFOX7方案全身化疗联合卡瑞利珠单克隆抗体和阿帕替尼治疗肝细胞癌合并Vp4型门静脉癌栓的疗效。方法采用单臂、开放、探索性临床研究方法。收集2021年4月至2023年10月中山大学孙逸仙纪念医院收治的15例肝细胞癌合并Vp4型门静脉癌栓患者的临床病理资料;男14例,女1例;年龄为48(33~67)岁。患者均行mFOLFOX7方案+卡瑞利珠单克隆抗体+阿帕替尼治疗。观察指标:(1)临床疗效。(2)生存情况。偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示。结果(1)临床疗效。15例患者均行mFOLFOX7方案+卡瑞利珠单克隆抗体+阿帕替尼治疗。根据实体瘤反应评价标准v1.1评估,15例患者客观缓解占比为10/15,完全缓解占比为1/15,部分缓解占比为9/15,疾病控制占比为15/15;中位无进展生存时间和中位总生存时间均未达到(>9个月)。根据改良实体瘤反应评价标准评估,15例患者客观缓解占比为12/15,完全缓解占比为6/15,部分缓解占比为6/15,疾病控制占比为15/15;中位无进展生存时间和中位总生存时间均未达到(>9个月)。15例患者中,7例成功转化(手术转化占比为7/15,均实现R0切除),6例转化失败,2例尚在转化治疗。7例成功转化患者中,5例病理学完全缓解;1例主要病理学缓解,90%肿瘤坏死;1例影像学检查完全缓解,但在继续观察中肝脏出现多处新发病灶,予以手术切除,组织病理学检查证实有肝内多发转移。15例患者治疗相关不良反应发生占比为13/15,其中≥3级不良反应发生占比为7/15,包括腹泻(3/15)、中性粒细胞减少(2/15)、血小板减少(2/15)和丙氨酸转氨酶增高(2/15)。同1例患者可发生≥1种不良反应。患者均经对症治疗后好转。(2)生存情况。15例患者均获得随访,随访时间为13.0(2.0~31.0)个月。随访期间3例患者死亡,其中1例为部分缓解,发生上消化道出血死亡,生存时间为7.5个月;1例为�Objective To investigate the efficacy of mFOLFOX7 regimen systemic chemotherapy combined with camrelizumab and apatinib for hepatocellular carcinoma(HCC)with Vp4 portal vain tumor thrombus(PVTT).Methods The single-arm,open,exploratory clinical study was conducted.The clinicopathological data of 15 HCC patients with Vp4 PVTT who were admitted to the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from April 2021 to October 2023 were collected.There were 14 males and 1 female,aged 48(range,33−67)years.All patients underwent treatment with mFOLFOX7 regimen combined with camrelizumab and apatinib.Observation indicators:(1)clinical efficacy;(2)survival of patients.Measurement data with skewed distribution were represented as M(rang),and count data were described as absolute numbers or percentages.Results(1)Clinical efficacy.All 15 patients underwent treatment with mFOLFOX7 regimen combined with camrelizumab and apatinib.According to the response evaluation criteria in solid tumors version 1.1,the ratio of objective response,ratio of complete response,ratio of partial response,ratio of disease control,median progression free survival time and median total survival time of the 15 patients were 10/15,1/15,9/15,15/15,not reached and not reached.The median progression free survival time and median total survival time were both>9 months.According to the modified response evaluation criteria in solid tumors,the ratio of objective response,ratio of complete response,ratio of partial response,ratio of disease control,median progression free survival time and median total survival time of the 15 patients were 12/15,6/15,6/15,15/15,not reached and not reached.The median progression free survival time and median total survival time were both>9 months.Of the 15 patients,7 cases were successfully treated with conversion therapy with the surgical conversion rate as 7/15,and all of them achieved R0 resection.The other 6 cases were failed in conversion therapy,and there were 2 cases still undergoing conversion therapy.Of the

关 键 词：肝肿瘤 门静脉癌栓 全身化疗 免疫检查点抑制剂 抗血管生成靶向药物 疗效 

分 类 号：R735.7[医药卫生—肿瘤]