最初不可切除的肝癌转化降期后手术切除的安全性和预后分析  

Safety and Prognostic Analysis of Surgical Resection after Conversion Therapy and Downgrading of Initial Unresectable Advanced Hepatocellular Carcinoma

作　　者：朱恽 侯天奇 张斌 曹宽 单文刚 王人颢 ZHU Yun;HOU Tianqi;ZHANG Bin(Department of Hepatopancreatobiliary Surgery,Affiliated Hospital of Xuzhou Medical University,Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属医院肝胆胰外科,221000

出　　处：《医学研究杂志》2024年第11期117-122,126,共7页Journal of Medical Research

基　　金：江苏省徐州市推动科技创新专项资金资助项目(KC23152)。

摘　　要：目的 探讨最初不可切除的肝癌转化降期后手术切除的安全性和预后分析。方法 回顾性分析2019年1月~2021年12月于徐州医科大学附属医院接受酪氨酸激酶抑制剂(tyrosine kinase inhibitor, TKI)和程序性死亡受体-1(programmed death-1,PD-1)抑制剂联合治疗的53例不可切除肝癌患者。根据改良实体瘤临床疗效评价标准(modified response evaluation criteria in solid tumors, mRECIST)评估肿瘤反应和可切除性,着重分析手术切除患者的临床特点、转化治疗效果、药物不良反应、手术情况、术后并发症情况和生存情况,评估手术安全性以及预后。结果 最初不可切除的53例肝癌患者中,12例(22.6%)患者在联合治疗开始后101(92,153)天内接受了R_0切除术。在最初检查时,这12例患者的中位肿瘤最大径为8.2(4.7,10.3)cm,有6例为CNLCⅢa期;4例为CNLCⅢb期,包括3例腹膜后淋巴结转移,1例左侧肾上腺转移。手术前评估:完全缓解2例,部分缓解9例,疾病稳定1例。术后发生Ⅱ级及以上并发症共3例,术后6个月、1年以及2年累积生存率分别为100.0%、91.7%、66.7%,无复发生存率分别为91.7%、66.7%、50.0%。结论 经过术前全面评估,最初不可切除的肝癌转化降期后手术切除初步证实是安全、有效的。Objective To investigate the safety and prognostic analysis of surgical resection after conversion therapy and downgrading of initial unresectable advanced hepatocellular carcinoma.Methods Clinical data was retrospectivly collected from 53 unresectable advanced hepatocellular carcinoma patients who received combined treatment with tyrosine kinase inhibitor(TKI)and programmed death-1(PD-1)inhibitors in the Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2021.Tumor response and resectability were evaluated through modified response evaluation criteria in solid tumors(mRECIST).Emphasis was placed on analyzing the clinical characteristics,effects of conversion therapy,adverse drug reactions,surgical outcomes,postoperative complications and survival of patients undergoing surgical resection,in order to evaluate surgical safety and prognosis.Results Among 53 patients with initially unresectable advanced liver cancer,12 patients(22.6%)underwent R 0 resection surgery within 101(92,153)days after the start of combination therapy.At the initial examination,the median maximum tumor diameter of these 12 patients was 8.2(4.7,10.3)cm,and 6 patients of them were in CNLCⅢa stage;4 patients were in CNLCⅢb stage,including 3 patients of retroperitoneal lymph node metastasis and 1 patient of left adrenal metastasis.Preoperative evaluation:2 patients showed complete remission,9 patients showed partial remission,and 1 patient showed stable disease.There were 3 patients of postoperative complications of gradeⅡor above.The cumulative postoperative survival rates at 6months,1 year,and 2 years were 100.0%,91.7%,and 66.7%,respectively.The recurrence-free survival rates at 6months,1 year,and 2 years were 91.7%,66.7%,and 50.0%,respectively.Conclusion After full preoperative evaluation,surgical resection is safe and effective for the initial unresectable advanced liver cancer after conversion therapy and downgrading.

关 键 词：肝癌 肝切除术 转化治疗 靶向治疗 PD-1抑制剂 

分 类 号：R735.7[医药卫生—肿瘤]