索拉非尼联合TACE术治疗中晚期肝细胞癌30例临床观察

目的观察索拉菲尼联合经导管肝动脉化疗栓塞术（TACE）对中晚期肝细胞癌的疗效以及血清血管内皮生长因子的变化。方法将2007年12月至2009年4月入住我院无法手术切除的中晚期肝细胞癌患者60例随机分为两组,每组各30例。治疗组：索拉菲尼＋TACE术。对照组：单纯行TACE术。索拉菲尼于TACE术后5d开始口服。400mgbid,至少服用3个月,每位患者行TACE术不少于两次,并检测TACE术前1周及术后2周血清VEGF水平。结果治疗组有效率为50.0%,对照组36.7%,组间比较差异无统计学意义（P〉0.05）;治疗组疾病控制率为83.3%,对照组53.3%,组间比较差异有统计学意义（P〈0.05）;治疗组中位肿瘤进展时间为6.2个月,对照组中位TTP为3.1个月,组间比较差异有统计学意义（P〈0.001）;治疗组1年生存率为83.3%,对照组为56.7%,组间比较差异有统计学意义（P〈0.05）;治疗组血清VEGF下降显著（P〈0.05）,对照组治疗前后血清VEGF水平对比,差异无统计学意义（P〉0.05）。治疗组及对照组毒副反应均为Ⅰ-Ⅲ度,经对症处理后症状可缓解。治疗组腹泻、手足综合征、皮疹、高血压等症状与对照组比较,差异有统计学意义。结论索拉菲尼联合TACE术能改善不能手术中晚期肝癌患者的疾病控制率,并降低血清VEGF水平,可延长患者生存期且其毒副作用可以耐受。

Sorafenib combined with transcatheter arterial chemoembolization in the treatment Of advanced hepatocellular carcinoma

Objective To evaluate the efficacy of sorafenib combined with transcatheter arterial chemoembolization in the treatment of advanced hepatocellular carcinoma.Methods From December 2007 to April 2009,60 patients with advanced hepatocellular carcinoma were randomized into the treatment group （TACE plus sorafenib） and the control group （TACE alone）.The treatment group received oral administration of sorafenib（400 mg bid） for at least 3 months.Both groups underwent TACE at least twice.Before and after the treatment,the enzyme linked immunosorbentassay （ELISA） was used to examine the change of VEGF.Results Of 60 assessable patients,overall response rate was 50.0% in treatment group and 36.7% in control group respectively （P0.05）.The disease control rate was 83.3% in treatment group and 53.3% in control group （P0.05）.The time to progression was 6.2 months in treatment group and 3.1 months in control group（ P0.05）.The 1-year survival rate were 83.3% in treatment group and 56.7% in control group （P0.05）.The levels of serum VEGF in treatment group were significantly decreased after treatment in effective cases （P0.05）.There was no significant difference between the levels of serum VEGF before and after treatment in control group.Adverse reactions in both groups were grade ⅠtoⅢ.The most common adverse events were diarrhea,hand-foot syndrome,rashes and hypertension in treatment group.Conclusion Sorafenib plus TACE can prolong the survival of advanced hepatocellular carcinoma,with tolerable side effect.