TACE联合125I粒子植入与TACE联合仑伐替尼治疗肝细胞癌合并门静脉癌栓的疗效比较  

Comparison of efficacy of transarterial chemoembolization(TACE)combined with 125I particle implantation and TACE combined with lenvatinib in treatment of hepatocellular carcinoma(HCC)with portal vein tumor thrombosis(PVTT)

作　　者：郭明皓 樊喜文[1] GUO Minghao;FAN Xiwen(Department of Interventional Diagnosis and Treatment,the Affiliated Tumor Hospital of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学附属肿瘤医院介入诊疗科,乌鲁木齐830011

出　　处：《新疆医科大学学报》2025年第2期149-155,共7页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区科技支疆项目(2022E02048)。

摘　　要：目的探究肝动脉化疗栓塞(Transarterial chemoembolization,TACE)联合125I粒子植入与TACE联合仑伐替尼治疗肝细胞癌(Hepatocellular carcinoma,HCC)合并门静脉癌栓(Portal vein tumor thrombosis,PVTT)的疗效差异比较。方法回顾性分析2019年1月1日-2022年12月31日就诊于新疆医科大学附属肿瘤医院介入科的46名原发性肝癌合并程氏Ⅱ型门静脉癌栓的患者,其中行TACE+125I粒子植入术治疗的患者21名,行TACE+仑伐替尼治疗的患者25名,对比两组患者的基线资料、治疗肝内病灶及门脉癌栓的ORR、DCR,对比术前、术后一个月、术后三个月肝功能,包括总胆红素、白蛋白、凝血酶原时间、有无肝性脑病、有无中-大量腹水,并绘制生存曲线。结果在治疗门静脉癌栓方面,与仑伐替尼联合组相比,粒子联合组有更好的ORR与DCR(χ^(2)=9.385、7.415,P=0.002、0.006);术后三个月复查肝功能指标,与仑伐替尼联合组相比,粒子联合组患者的总胆红素指标较低(t=-2.332,P=0.024);粒子联合组相比仑伐替尼联合组取得了更长的中位PFS(10.1个月对比7.2个月,χ^(2)=4.326,P=0.038);仑伐替尼联合组的中位OS稍长于粒子联合组,两组无统计学差异(14.4个月比13.5个月,χ^(2)=2.156,P=0.142)。在不良事件方面,相比仑伐替尼联合组,粒子联合组治疗后发生手足综合征、血小板减少的患者更少(χ^(2)=4.935,4.031;P=0.026,0.045)。结论TACE联合125I粒子植入或仑伐替尼在治疗肝内原发病灶方面,两种方法的疗效无差异;TACE联合125I粒子植入针对门静脉癌栓的疗效更好,更有助于改善肝功能,不良反应更少。Objective To explore the therapeutic differences between transarterial chemoembolization(TACE)combined with 125I particle implantation and TACE combined with lenvatinib in the treatment of hepa-tocellular carcinoma(HCC)with portal vein tumor thrombosis(PVTT).Methods The research conducted a retrospective analysis of 46 patients with HCC and Cheng's type II PVTT admitted to the hospital from January 1,2019 to December 31,2022.Among them,21 patients underwent TACE+125I particle implantation surgery and 25 patients underwent TACE+lenvatinib treatment.Baseline data,ORR and DCR of treated intrahepatic lesions and portal vein cancer thrombus were compared between the 2 groups,and liver function was compared before,1 month after,and 3 months after the surgery,including total bilirubin,albumin,prothrombin time,presence or absence of hepatic encephalopathy,presence or absence of moderate to large amounts of ascites and survival curves were plotted.Results In the treatment of portal cancer thrombus,compared with the lenvatinib combination group,the particle combination group had better ORR and DCR(χ^(2)=9.385,7.415,P=0.002,0.006).Compared with the lenvatinib combination group,the total bilirubin index of the patients in the particle combination group was lower(t=-2.332,P=0.024).The median PFS was longer in the particle combination group than in the lenvatinib combination group(10.1 months versus 7.2 months,χ^(2)=4.326,P=0.038).The median OS of the lenvatinib combination group was slightly longer than that of the particle combination group,and there was no statistically significant difference between the 2 groups(14.4 months versus 13.5 months,χ^(2)=2.156,P=0.142).In terms of adverse events,compared with the lenvatinib combination group,fewer patients with hand-foot syndrome and thrombocytopenia developed after the treatment in the particle combination group(χ^(2)=4.935,4.031;P=0.026,0.045).Conclusion The efficacy of TACE combined with 125I particle implantation compared to lenvatinib in treating primary liver cancer sh

关 键 词：肝细胞癌 门脉癌栓 肝动脉化疗栓塞 放射性粒子 仑伐替尼 联合治疗 

分 类 号：R735.7[医药卫生—肿瘤]