TACE联合小剂量阿帕替尼治疗肝细胞癌合并门静脉癌栓

目的观察TACE联合小剂量阿帕替尼治疗肝细胞癌(HCC)合并门静脉癌栓的价值。方法将90例不可手术切除的原发性HCC合并门静脉癌栓患者随机分为治疗组及对照组,其中治疗组38例于TACE治疗后第3天开始口服小剂量(每日250 mg)阿帕替尼;对照组52例接受单纯TACE治疗。术后随访,比较2组间治疗前后甲胎蛋白水平及生存期的差异,分析2组患者的治疗有效率及术后不良反应情况。结果 2组患者TACE治疗的技术成功率均为100%。2组间治疗前甲胎蛋白水平差异无统计学意义(t=20.15,P=0.08),治疗组术后1、3、6、12个月甲胎蛋白水平均较对照组明显下降(P均0.05)。治疗组术后1、3、6、12、24个月肿瘤治疗有效率分别为89.47%(34/38)、84.21%(32/38)、78.95%(30/38)、34.21%(13/38)和10.53%(4/38);对照组分别为75.00%(39/52)、67.31%(35/52)、25.00%(13/52)、3.85%(2/52)和19.23%(10/52)。治疗组患者术后平均生存期明显长于对照组[(17.12±1.55)个月vs (14.21±2.13)个月,P=0.01]。虽然治疗组术后不良反应手足综合征、皮疹、腹泻、腹痛、消化道出血、蛋白尿、血尿、肌酐及尿素氮升高、眩晕、头痛、高血压、红细胞减少、白细胞减少、血红蛋白水平减低、血小板减少、转氨酶升高、胆红素升高的发生率均明显高于对照组(P均0.01),但其中美国国家癌症研究所(NCI)癌症常见毒性反应事件评价标准3级以上者较少。结论 TACE联合小剂量阿帕替尼治疗HCC在控制肿瘤及其合并癌栓进展方面优于单纯TACE,可有效延长患者生存期。

TACE combined with little dose Apatinib in treatment of hepatcellular carcinoma with portal vein thrombus

Objective To observe the value of TACE combined with little dose Apatinib in treatment of hepatcellular carcinoma (HCC) with portal vein thrombi. Methods Totally 90 unrectable HCC patients with portal vein thrombi were randomly divided into treatment group and control group. Patients in treatment groups (n=38) were started oral little Apatinib 250 mg/d from 3 days after TACE. Patients in control group (n=52) were only underwent TACE. Postoperaion follow up was performed. The level of alpha fetal protein (AFP), survival time difference and response efficacy rate between 2 groups were compared. The postoperation untoward effects were also analyzed between 2 groups. Results The operation sucess rates were both 100% in both groups. The AFP level of preoperation between 2 groups had no significant difference (t=20.15, P=0.08). The levels of AFP in treatment group postoperation 1 month, 3 months, 6 months, 12 months and 24 months were obviously decreased than those in control group (all P<0.05). The response efficacy rates in treatment group postoperation 1 month, 3 months, 6 months, 12 months and 24 months were 89.47%(34/38), 84.21%(32/38), 78.95%(30/38), 34.21%(13/38) and 10.53%(4/38), respectively; while those in control group were 75.00%(39/52), 67.31%(35/52), 25.00%(13/52), 3.85%(2/52) and 19.23%(10/52), respectively. The mean life time in treatment group was longer than that in control group ([17.12±1.55] months vs[14.21±2.13] months, P=0.01). Although the occurrence rates of hand-foot syndrome, erythra, diarrhoea, abdominal pain, gastrointestinal bleeding, proteinuria, haematuria, high creatinine and urea nitrogen, vertigo, headache, hypertention, erythropenia, leukopenia, low haemoglobin, low platelet, high transaminase, high bilrubin in treatment group were obviously more than control group (all P<0.01), most of them were lower than 3 grade according to the evaluation stantard of National Cancer Institute (NCI). Conclusion TACE combined with little dose Apatinib are superior to single TACE in treatment of HCC with portal vein thrombi which can effectively prolong median lifetime.