肝动脉化疗栓塞术不同化疗方案治疗原发性肝癌的疗效及安全性

doi:10.3969/j.issn.1006⁃5725.2022.05.014

实用医学杂志 ›› 2022, Vol. 38 ›› Issue (5): 594-599.doi: 10.3969/j.issn.1006⁃5725.2022.05.014

肝动脉化疗栓塞术不同化疗方案治疗原发性肝癌的疗效及安全性

杨凯仑1 李智1 任起梦2 刘钊1 毛鑫宇1 朱晓黎1 倪才方1

1 苏州大学附属第一医院介入科（江苏苏州 215006）；2 上海交通大学医学院九龙医院（江苏苏州 215006）

出版日期:2022-03-10 发布日期:2022-02-10
通讯作者: 李智 E⁃mail：lizhisoochow1983@163.com
基金资助:
江苏省卫生人才“六个一工程”拔尖人才项目（编号：LGY2018077）

The efficacy and safety of TACE with different chemotherapy regimens in the treatment of primary liver cancer

YANG Kailun*，LI Zhi，REN Qimeng，LIU Zhao，MAO Xinyu，ZHU Xiaoli，NI Caifang.

Department of Interventional Radiology，First Affiliated Hospital of Soochow University，Suzhou 215006，China

Online:2022-03-10 Published:2022-02-10
Contact: LI Zhi E⁃mail：lizhisoochow1983@163.com

摘要/Abstract

摘要：

目的比较肝动脉化疗栓塞（TACE）不同化疗方案治疗原发性肝癌的疗效和安全性。方法选取我中心 2012 年 1 月至 2019 年 1 月完成的 TACE 手术患者 136 例，根据 TACE 中不同化疗方案将患者分为 A、B 两组。A 组（98 例）化疗方案为氟脲苷 1 000 mg +奥沙利铂100 mg +吡柔比星40 mg，部分与碘油乳化后栓塞，部分经肠系膜上动脉、肝动脉灌注。B 组（38 例）为奥沙利铂 100 mg，全部与碘油乳化后栓塞。以客观缓解率（objective response rate，ORR）、疾病控制率（disease control rate，DCR）、无进展生存时间（progression free survival，PFS）评价有效性，以严重并发症发生率评价安全性。结果 A 组的 ORR 为 53.1%（52/98），B组为36.8%（14/38），差异无统计学意义（χ2 = 2.884，P = 0.089）。A组的DCR为82.7%（81/98）， B 组为 71.1%（27/38），差异无统计学意义（χ2 = 2.254，P = 0.133）。A 组的中位 PFS为192 d（95%CI：152 ~ 231），B组为183 d（95%CI：60 ~ 305），差异无统计学意义（χ2 = 1.081，P = 0.299）。多因素回归分析显示，影响 PFS的独立危险因素为肝外转移（HR = 2.283，95%CI：0.25 ~ 0.77；P = 0.004）。A 组严重不良反应发生率为 15.3%（15/98），B 组为 2.6%（1/38），差异有统计学意义（P = 0.04）。结论单药低化疗剂量 TACE 治疗原发性肝癌的疗效与3药高化疗剂量TACE 相同，但并发症发生率降低，安全性提高。

关键词:

原发性肝癌, , 动脉化疗栓塞, , 化疗方案, , 剂量, , 安全性

Abstract:

Objective To compare the efficacy and safety of different chemotherapy regimens used in TACE for the treatment of primary liver cancer. Methods 136 patients with primary liver cancer who had received transcatheter arterial chemoembolization（TACE）from January 2012 to January 2019 in our center were selected. Patients were divided into group A and group B according to different chemotherapy regimens in TACE. Group A received chemotherapy regimen with fluorouracil 1 000 mg plus oxaliplatin 100 mg and pirarubicin 40 mg，which was partially emulsified with lipiodol and then for embolization，and partially perfused through superior mesenteric artery and hepatic artery. In group B，oxaliplatin 100 mg was emulsified with lipiodol for embolization. Objective re⁃ sponse rate（ORR），disease control rate（DCR），and progression⁃free survival（PFS）were used to evaluate the effectiveness of the therapies；the incidence of serious complications was used to assess the safety. Results A total of 136 patients met the inclusion criteria，including 98 in group A and 38 in group B. There were no significant differences in the baseline characteristics between the two groups. The ORR was 53.1 %（52/98）in group A and 36.8%（14/38）in group B，and the difference was not statistically significant（χ2 = 2.884，P = 0.089）. The DCR was 82.7 %（81/98）in group A and 71.1 %（27/38）in group B，and the difference was not statistically significant （χ2 = 2.254，P = 0.133）. The median PFS was 192 days（95%CI：152~231）in group A and 183 days（95%CI： 60~305）in group B，and the difference was not statistically significant（χ2 = 1.081，P = 0.299）. Multivariate regression analysis showed that the only independent risk factor for PFS was extrahepatic metastasis（HR = 2.283， 95%CI：0.25 ~ 0.77，P = 0.004）. The incidence of serious adverse reactions was 15.3 %（15/98）in group A and 2.6%（1/38）in group B，and the difference was statistically significant（P = 0.04）. Conclusions The efficacy of TACE with low⁃dose monotherapy for primary liver cancer is the same as that of TACE with high⁃dose polytherapy. For the low⁃dose monotherapy，the incidence of complications is reduced and the safety of therapies is improved.

Key words:

primary liver cancer, transcatheter arterial chemoembolization, chemotherapy regimens, dosage, safety

杨凯仑李智任起梦刘钊毛鑫宇朱晓黎倪才方.

肝动脉化疗栓塞术不同化疗方案治疗原发性肝癌的疗效及安全性 [J]. 实用医学杂志, 2022, 38(5): 594-599.

YANG Kailun, LI Zhi, REN Qimeng, LIU Zhao, MAO Xinyu, ZHU Xiaoli, NI Caifang. .

The efficacy and safety of TACE with different chemotherapy regimens in the treatment of primary liver cancer [J]. The Journal of Practical Medicine, 2022, 38(5): 594-599.

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肝动脉化疗栓塞术不同化疗方案治疗原发性肝癌的疗效及安全性

The efficacy and safety of TACE with different chemotherapy regimens in the treatment of primary liver cancer

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