切换至 "中华医学电子期刊资源库"
高级检索
中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2019, Vol. 08 ›› Issue (06) : 547 -551. doi: 10.3877/cma.j.issn.2095-3232.2019.06.018

所属专题： 文献；

临床研究

TACE与射频消融联合索拉非尼治疗多发性肝癌合并门静脉癌栓的疗效
彭国文1,†(), 史德刚1, 陈迪耀1, 王健鹏1   
  1. 1. 528000　广东省佛山市第一人民医院肿瘤靶向介入科
  • 收稿日期:2019-08-10 出版日期:2019-12-10
  • 通信作者: 彭国文

Clinical efficacy of TACE ablation combined with radiofrequency and sorafenib in treatment of multiple liver cancer complicated with portal vein tumor thrombus

Guowen Peng1,†(), Degang Shi1, Diyao Chen1, Jianpeng Wang1   

  1. 1. Department of Targeted Tumor Intervention, the First People's Hospital of Foshan, Foshan 528000, China
  • Received:2019-08-10 Published:2019-12-10
  • Corresponding author: Guowen Peng
  • About author:
    Corresponding author: Peng Guowen, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

彭国文, 史德刚, 陈迪耀, 王健鹏. TACE与射频消融联合索拉非尼治疗多发性肝癌合并门静脉癌栓的疗效[J]. 中华肝脏外科手术学电子杂志, 2019, 08(06): 547-551.

Guowen Peng, Degang Shi, Diyao Chen, Jianpeng Wang. Clinical efficacy of TACE ablation combined with radiofrequency and sorafenib in treatment of multiple liver cancer complicated with portal vein tumor thrombus[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(06): 547-551.

目的

探讨TACE与射频消融（RFA）联合索拉非尼治疗多发性肝癌合并门静脉癌栓的疗效。

方法

回顾性分析2014年1月至2018年1月在佛山市第一人民医院收治的68例多发性肝癌合并门静脉癌栓患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男44例，女24例；年龄28～58岁，中位年龄44岁。根据治疗方式将患者分为索拉非尼组和TACE+RFA组，两组各34例。索拉非尼组予以TACE+RFA联合索拉非尼治疗。两组患者肝功能、AFP、VEGF水平比较采用t检验，不良反应发生率和生存率比较采用χ2检验。

结果

索拉非尼组患者治疗后1个月客观缓解率和疾病控制率分别为62%（21/34）、85%（29/34），明显高于TACE+RFA组的41%（14/34）、74%（25/34）（χ2=2.885，1.439；P<0.05）。治疗后索拉非尼组AFP和VEGF水平分别为（251±43）、（106±10）μg/L，明显低于TACE+RFA组的（421±68）、（154±13）μg/L（t=-3.023，-3.321；P<0.05）。索拉非尼组皮疹、呕吐发生率分别为24%（8/34）、29%（10/34），明显高于TACE+RFA组的6%（2/34）、9%（3/34） （χ2=4.221，4.660；P<0.05）。索拉非尼组1年生存率为88%（30/34），明显高于TACE+RFA组的68%（23/34） （χ2=12.645，P<0.05）。

结论

TACE+RFA联合索拉非尼是晚期肝癌患者有效的治疗方法，可用于多发性肝癌合并门静脉癌栓患者的临床治疗，但应注意其不良反应与相关并发症。

关键词: 癌，肝细胞, 经导管动脉化疗栓塞, 射频消融, 索拉非尼
Objective

To evaluate the clinical efficacy of TACE combined with radiofrequency ablation (RFA) and sorafenib in the treatment of multiple liver cancer complicated with portal vein tumor thrombus.

Methods

Clinical data of 68 patients with multiple liver cancer complicated with portal vein tumor thrombus admitted to the First People's Hospital of Foshan from January 2014 to January 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 44 patients were male and 24 female, aged from 28 to 58 years old with a median age of 44. All 68 patients were divided into the sorafenib group and TACE+RFA group according to different treatments, with 34 cases in each group. In sorafenib group, TACE+RFA combined with sorafenib was delivered. The liver function, AFP and VEGF levels were statistically compared between two groups by t test. The incidence of adverse reactions and survival rate were statistically compared by Chi-square test.

Results

In sorafenib group, the objective remission rate and disease control rate were 62%(21/34) and 85% (29/34), significantly higher than 41%(14/34) and 74%(25/34) in TACE+RFA group (χ2=2.885, 1.439; P<0.05). After treatments, the AFP and VEGF levels in sorafenib group were (251±43) and (106±10) μg/L,significantly lower compared with (421±68) and (154±13) μg/L in TACE+RFA group (t=-3.023, -3.321; P<0.05). The incidence of rash and vomiting in sorafenib group was 24%(8/34) and 29%(10/34), significantly higher than 6% (2/34) and 9% (3/34) in TACE+RFA group (χ2=4.221, 4.660; P<0.05). In sorafenib group, the 1-year survival rate was 88% (30/34), significantly higher than 68%(23/34) in TACE+RFA group (χ2=12.645, P<0.05).

Conclusions

TACE+RFA combined with sorafenib is an efficacious treatment for advanced liver cancer. It can be used in treating multiple liver cancer complicated with portal vein tumor thrombus. Nevertheless, extensive attention should be paid to the adverse reactions and relevant complications.

Key words: Carcinoma, hepatocellular, Transcatheter arterial chemoembolization, Radiofrequency ablation, Sorafenib
表1 索拉非尼组与TACE+RFA组多发性肝癌合并门静脉癌栓患者一般情况比较
组别 例数 性别 年龄（岁，±s ） AFP （μg/L，±s ） 肿瘤最大直径（cm，±s ） 肝功能Child-Pugh分级（例）
男 女 A级 B级
索拉非尼组 34 21 13 43±15 845±125 6.0±1.1 10 24
TACE+RFA组 34 23 11 46±17 805±201 5.8±1.0 8 26
统计值 ? χ2=0.258 t=-0.151 t=0.179 t=0.191 χ2=0.302
P值 ? 0.611 0.803 0.782 0.742 0.582
表2 索拉非尼组与TACE+RFA组多发性肝癌合并门静脉癌栓患者治疗前后临床指标比较（ ±s ）
组别 例数 治疗前
AST（U/L） ALT（U/L） TB（μmol/L） AFP（μg/L） VEGF（μg/L）
索拉非尼组 34 162±32 144±25 66±5 845±125 203±26
TACE+RFA组 34 178±30 140±20 60±9 805±201 198±32
t值 ? -0.125 0.136 0.621 0.179 0.135
P值 ? 0.872 0.829 0.382 0.782 0.827
组别 例数 治疗后
AST（U/L） ALT（U/L） TB（μmol/L） AFP（μg/L） VEGF（μg/L）
索拉非尼组 34 87±11 92±13 40±5 251±43 106±10
TACE+RFA组 34 80±12 89±8 39±7 421±68 154±13
t值 ? 0.179 0.204 0.278 -3.023 -3.321
P值 ? 0.782 0.727 0.631 <0.001 <0.001
表3 索拉非尼组与TACE+RFA组多发性肝癌合并门静脉癌栓患者介入术后疗效情况[例（%）]
组别 例数 CR PR PD SD
索拉非尼组 34 9(26) 12(35) 5(15) 08(26)
TACE+RFA组 34 4(12) 10(29) 9(26) 11(32)
表4 索拉非尼组与TACE+RFA组多发性肝癌合并门静脉癌栓患者治疗后不良反应发生情况比较[例（%）]
组别 例数 皮疹 腹泻 呕吐 发热 高血压 消化道出血
索拉非尼组 34 8(24) 4(12) 10(29) 2(6) 2(6) 3(9)
TACE+RFA组 34 2(6) 3(9) 03(9) 4(12) 1(3) 1(3)
χ2值 ? 4.221 0.159 4.660 0.731 0.349 1.063
P值 ? 0.039 0.690 0.030 0.392 0.554 0.302
[1]
Njei B, Rotman Y, Ditah I, et al. Emerging trends in hepatocellular carcinoma incidence and mortality[J]. Hepatology, 2015, 61(1):191-199.
[2]
Clark T, Maximin S, Meier J, et al. Hepatocellular carcinoma: review of epidemiology, screening, imaging diagnosis, response assessment, and treatment[J]. Curr Probl Diagn Radiol, 2015, 44(6):479-486.
[3]
邹英华，吕天石．肝动脉化疗栓塞术(TACE)联合射频消融术(RFA)治疗原发性肝癌研究进展[J/CD]．肝癌电子杂志，2014, 1(1):29-33.
[4]
Marisi G, Cucchetti A, Ulivi P, et al. Ten years of sorafenib in hepatocellular carcinoma: are there any predictive and/or prognostic markers? [J]. World J Gastroenterol, 2018, 24(36):4152-4163.
[5]
Wang HT, Xia M. A meta-analysis of efficacy and safety of sorafenib versus other targeted agents for metastatic renal cell carcinoma[J]. Medicine, 2019, 98(1):e13779.
[6]
Zhu ZX, Huang JW, Liao MH, et al. Treatment strategy for hepatocellular carcinoma in China: radiofrequency ablation versus liver resection[J]. Jpn J Clin Oncol, 2016, 46(12):1075-1080.
[7]
Han K, Kim JH. Transarterial chemoembolization in hepatocellular carcinoma treatment: Barcelona clinic liver cancer staging system[J]. World J Gastroenterol, 2015, 21(36):10327-10335.
[8]
Minami Y, Nishida N, Kudo M. Therapeutic response assessment of RFA for HCC: contrast-enhanced US, CT and MRI[J]. World J Gastroenterol, 2014, 20(15):4160-4166.
[9]
Higgins H, Berger DL. RFA for liver tumors: does it really work?[J]. Oncologist，2006，11(7):801-808.
[10]
高飞，庞志刚，韩斌，等．肝动脉化疗栓塞联合射频消融术治疗大肝癌的疗效及生存分析[J]．介入放射学杂志，2016, 25(4):316-319.
[11]
赵增富，王茹芳，任庆莹，等．肝动脉化疗栓塞联合射频消融治疗肝癌合并门静脉癌栓的疗效分析[J]．中国现代普通外科进展, 2014, 17(8):634-636.
[12]
Raoul JL, Kudo M, Finn RS, et al. Systemic therapy for intermediate and advanced hepatocellular carcinoma: Sorafenib and beyond[J]. Cancer Treat Rev, 2018(68):16-24.
[13]
Wen T, Xiao H, Luo C, et al. Efficacy of sequential therapies with sorafenib-sunitinib versus sunitinib-sorafenib in metastatic renal cell carcinoma: a systematic review and meta-analysis[J]. Oncotarget, 2017, 8(12):20441-20451.
[14]
Lee S, Cho YY, Cho EJ, et al. Synergistic effect of ursodeoxycholic acid on the antitumor activity of sorafenib in hepatocellular carcinoma cells via modulation of STAT3 and ERK[J]. Int J Mol Med, 2018, 42(5):2551-2559.
[15]
Yvamoto EY, Ferreira RF, Nogueira V, et al. Influence of vascular endothelial growth factor and alpha-fetoprotein on hepatocellular carcinoma[J]. Genet Mol Res, 2015, 14(4):17453-17462.
[16]
Ogasawara S, Chiba T, Ooka Y, et al. Characteristics of patients with sorafenib-treated advanced hepatocellular carcinoma eligible for second-line treatment[J]. Invest New Drugs, 2018, 36(2):332-339.
[17]
Zhu YJ, Zheng B, Wang HY, et al. New knowledge of the mechanisms of sorafenib resistance in liver cancer[J]. Acta Pharmacol Sin, 2017, 38(5):614-622.
[18]
Kuo YH, Wu IP, Wang JH, et al. The outcome of sorafenib monotherapy on hepatocellular carcinoma with portal vein tumor thrombosis[J]. Invest New Drugs, 2018, 36(2):307-314.
[19]
周松强，游燊，王耀东．索拉非尼联合肝动脉化疗栓塞术治疗晚期肝癌的临床疗效及安全性[J]．临床合理用药杂志，2018, 11(36):47-48.
[1] 涂鹏, 张晓航, 董虹美, 陈功立, 冉素真. 超声多普勒评估在双胎输血综合征射频消融减胎术后的应用价值[J]. 中华医学超声杂志（电子版）, 2023, 20(05): 492-497.
[2] 杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[3] 王兴, 张峰伟. 腹腔镜肝切除联合断面射频消融治疗伴微血管侵犯肝细胞癌的临床研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 580-583.
[4] 魏小勇. 原发性肝癌转化治疗焦点问题探讨[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 602-607.
[5] 张其坤, 商福超, 李琪, 栗光明, 王孟龙. 联合脾切除对肝癌合并门静脉高压症患者根治性切除术后的生存获益分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 613-618.
[6] 严庆, 刘颖, 邓斐文, 陈焕伟. 微血管侵犯对肝癌肝移植患者生存预后的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 624-629.
[7] 张文华, 陶焠, 胡添松. 不同部位外生型肝癌临床病理特点及其对术后肝内复发和预后影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 651-655.
[8] 韩宇, 张武, 李安琪, 陈文颖, 谢斯栋. MRI肝脏影像报告和数据系统对非肝硬化乙肝患者肝细胞癌的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 669-673.
[9] 张维志, 刘连新. 基于生物信息学分析IPO7在肝癌中的表达及意义[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 694-701.
[10] 陈安, 冯娟, 杨振宇, 杜锡林, 柏强善, 阴继凯, 臧莉, 鲁建国. 基于生物信息学分析CCN4在肝细胞癌中表达及其临床意义[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 702-707.
[11] 叶文涛, 吴忠均, 廖锐. 癌旁组织ALOX15表达与肝癌根治性切除术后预后的关系[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 708-712.
[12] 吴晨瑞, 廖锐, 贺强, 潘龙, 黄平, 曹洪祥, 赵益, 王永琛, 黄俊杰, 孙睿锐. MDT模式下肝动脉灌注化疗联合免疫靶向治疗肝细胞癌多处转移一例[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 713-716.
[13] 杜锡林, 谭凯, 贺小军, 白亮亮, 赵瑶瑶. 肝细胞癌转化治疗方式[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 597-601.
[14] 何传超, 肖治宇. 晚期肝癌综合治疗模式与策略[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 486-489.
[15] 王孟龙. 肿瘤生物学特征在肝癌肝移植治疗中的意义[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 490-494.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号