恶性胸/腹腔积液患者腔内应用贝伐珠单抗的价值及疗效影响因素分析

目的 观察胸腔或腹腔内注射贝伐珠单抗（bevacizumab，Bev）对恶性胸/腹腔积液的控制作用及其安全性，并探索影响疗效的可能因素。方法 回顾性分析61例恶性胸/腹腔积液患者的临床资料，其中接受过含Bev的方案腔内注射的患者24例，常规化疗方案腔内注射患者37例。根据无穿刺抽液间隔时间（paracentesis-free interval，PaFI）来评估疗效并比较两组间的差异，汇总记录的不良反应，并对相关临床特征、血液和积液中检查指标进行Cox回归分析。结果 含Bev的方案治疗的患者中位PaFI为115.0（55.3，219.0） d，较常规化疗组（53.0（32.0，147.5） d）明显延长（Z=2.340，P=0.019），以积液部位作为分层因素后的Kaplan-Meier分析亦提示含Bev的方案可延长PaFI （χ2=7.568，P=0.006）；多因素Cox回归分析发现除Bev治疗外，积液部位及积液中单核细胞和多核细胞的比例亦可影响患者的治疗效果（均有P<0.05）；两组间不良事件发生率无差异（χ2=0.008，P=0.930），且主要为导管相关并发症，药物直接相关的不良反应少。结论 含Bev的方案腔内给药在控制恶性胸腹腔积液方面优于传统腔内化疗方案，且安全性较好，不同积液部位及积液中单核细胞和多核细胞比例变化对疗效有一定影响。

Value and influencing factors of intra-cavity administration of bevacizumab for patients with malignant pleural effusion and ascites

Objective To observe the effects and safety of intra-thoracic or intraperitoneal administration of bevacizumab (Bev) in patients with malignant pleural effusion or ascites,and to explore the potential factors that influencezthe efficiency.Methods Clinical data of sixty-one cases with malignant pleural effusion or ascites who received intra-cavity injection of drugs were retrospectively analyzed,of which twenty-four patients were injected with bevacizumab-contained regimens,and thirty-seven patients were injected with traditional chemotherapy regimens.Paracentesis-free interval (PaFI) of the groups were compared to evaluate efficiency side events after administration of drugs were recorded.Cox regression was used to analyze the clinical characteristics,blood and general effusion test.Results Median PaFI in bevacizumab group was 115.0 (55.3,219.0) days,and was significantly longer than traditional therapy (53.0 (32.0,147.5) days),(Z =2.340,P =0.019).After stratified with effusion site,Kaplan-Meier analysis also demonstrated a significant benefit from bevacizumab therapy (x2 =7.568,P =0.006).Cox regression analysis concluded effusion site and ratio of monocytes and multinucleate cell counting in the effusion had influence on outcomes in addition to bevacizumab injection (all P ＜ 0.05).No differences were seen in side events between the two groups,side events rates were 41.67％ for bevacizumab group versus 40.54％ for traditional therapy group (x2 =0.008,P =0.930).The most common side event was catheter-related complications,not due to drugs.Conclusions Intra-thoracic or intraperitoneal administration of Bev was thought to more effective than traditional regimens in controlling malignant effusion with tolerable side effects.Effusion sites and ratio of monocytes and multinucleate cell counting in effusion may influence the outcomes.