微波消融联合仑伐替尼及HAIC或TACE治疗进展期HCC的疗效与安全性比较  

Comparative efficacy and safety of microwave ablation combined with lenvatinib and HAIC or TACE in the treatment of progressive HCC

作　　者：赵敬兵 钟晓蓉[2] 汪杰 李钊 吴建林 龚应年 余峰 周国俊 冷政伟[1,2] ZHAO Jingbing;ZHONG Xiaorong;WANG Jie;LI Zhao;WU Jianlin;GONG Yingnian;YU Feng;ZHOU Guojun;LENG Zhengwei(Department of Hepatobiliary Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Institute of Hepatobiliary,Pancreatic and Intestinal Diseases,North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]川北医学院附属医院肝胆外科,四川南充637000 [2]川北医学院肝胆胰肠疾病研究所,四川南充637000

出　　处：《现代医学》2024年第6期892-899,共8页Modern Medical Journal

基　　金：四川省医学科研课题计划(S20050);北京医卫健康公益会(XBZQ-23007)。

摘　　要：目的:对比微波消融术(MWA)联合仑伐替尼及肝动脉灌注化疗(HAIC)与肝动脉化疗栓塞术(TACE)治疗进展期原发性肝细胞性肝癌(HCC)的疗效与安全性。方法:采用回顾性评价方法,收集2019年10月至2022年10月于川北医学院附属医院接受MWA联合仑伐替尼及HAIC或TACE联合治疗进展期HCC的96例患者临床病例资料。其中MWA联合仑伐替尼及HAIC方案治疗的患者43例,MWA联合仑伐替尼及TACE方案治疗的患者53例。根据mRECIST评价标准评估客观缓解率(ORR)、疾病控制率(DCR)、不良事件发生发生率、无疾病进展生存期(PFS)和总生存期(OS)。结果:HAIC联合治疗组43例患者总体疗效评价ORR为67.4%,DCR为84.4%。TACE联合治疗组53例患者总体疗效评价ORR为32.1%,DCR为69.8%。HAIC联合治疗组、TACE联合治疗组中位PFS分别为13个月(95%CI 8~18)、9个月(95%CI 7.2~10.8)(P=0.042)。两组患者中位OS分别为18个月(95%CI 11~25)、14个月(95%CI 10.7~17.3)(P=0.342)。HAIC联合治疗组主要不良反应为呕吐、腹痛、下肢静脉血栓及化疗相关骨髓抑制,TACE联合治疗组主要不良反应为发热、腹痛、肝功能异常及血小板减少,并且两组患者均无治疗相关死亡事件。结论:MWA联合仑伐替尼及HAIC治疗进展期HCC相比于MWA联合仑伐替尼及TACE组治疗进展期HCC有更高的PFS,且不良反应发生率更低。Objective:To compare the efficacy and safety of microwave ablation(MWA)combined with lenvatinib and hepatic artery infusion chemotherapy(HAIC)with hepatic artery chemoembolization(TACE)for the treatment of progressive primary hepatocellular carcinoma(HCC).Methods:Clinical case data of 96 patients who received MWA combined with lenvatinib and HAIC or TACE combined for the treatment of progressive HCC at the Affiliated Hospital of Chuanbei Medical College from October 2019 to October 2022 were collected using a retrospective evaluation method.Among them,43 patients were treated with MWA combined with lenvatinib and HAIC regimen,and 53 patients were treated with MWA combined with lenvatinib and TACE regimen.Objective remission rate(ORR),disease control rate(DCR),incidence of adverse events,disease progression-free survival(PFS)and overall survival(OS)were assessed according to mRECIST evaluation criteria.Results:The overall efficacy evaluation ORR was 67.4%and DCR was 84.4%for 43 patients in the HAIC combination therapy group.The overall efficacy evaluation ORR was 32.1%and DCR was 69.8%for 53 patients in the TACE combination therapy group.The median PFS for the HAIC combination therapy group and the TACE combination therapy group was 13 months(95%CI 8-18),9 months(95%CI 7.2-10.8)(P=0.042).The median OS was 18 months(95%CI 11-25)and 14 months(95%CI 10.7-17.3)in the two groups,respectively(P=0.342).Major adverse effects in the HAIC combination therapy group were vomiting,abdominal pain,lower extremity venous thrombosis and chemotherapy-related bone marrow suppression,while the major adverse effects in the TACE combination therapy group were fever,abdominal pain,liver function abnormalities and thrombocytopenia.And there were no treatment-related deaths in both groups.Conclusion:MWA combined with lenvatinib and HAIC for the treatment of progressive HCC had a higher PFS and a lower incidence of adverse events than MWA combined with lenvatinib and TACE for the treatment of progressive HCC.

关 键 词：原发性肝细胞性肝癌 肝动脉化疗栓塞术 肝动脉灌注化疗 微波消融 仑伐替尼 

分 类 号：R657.3[医药卫生—外科学]