门静脉癌栓对FOLFOX4方案系统治疗晚期肝细胞癌效果的影响

杨光; 董亚冰; 赵玲玲; 崔国振; 赵恒军; 王楠娅

doi:10.3969/j.issn.1001-5256.2018.10.016

门静脉癌栓对FOLFOX4方案系统治疗晚期肝细胞癌效果的影响

DOI: 10.3969/j.issn.1001-5256.2018.10.016

吉林大学第一医院肿瘤中心

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中图分类号: R735.7
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出版历程
- 收稿日期: 2018-03-26
- 出版日期: 2018-10-20

Influence of portal vein tumor thrombus on the clincial effect of FOLFOX4 chemotherapy regimen in treatment of advanced hepatocellular carcinoma

Cancer Center, The First Hospital of Jilin University

摘要

摘要: 目的探讨含奥沙利铂化疗方案治疗存在门静脉癌栓的晚期肝细胞癌的临床效果。方法回顾性分析2013年12月-2017年6月在吉林大学第一医院肿瘤中心确诊为BCLC C期的肝细胞癌患者的临床资料,所有患者均接受FOLFOX4方案系统化疗2疗程以上。按照是否合并门静脉癌栓分为2组:无门脉癌栓20例,有门静脉癌栓组17例,分析疗效与是否存在门静脉癌的关系。计数资料2组间比较采用χ2检验或Fisher精确检验,计量资料2组间比较采用Mann Whitney U检验。生存分析采用Kaplan Meier估算,组间生存曲线的比较则用log-rank检验,用Cox比例风险模型进行多变量分析,以风险比（HR）和95%可信区间（95%CI）表示。结果 37例患者中位无进展生存期为4个月（130个月）,中位总生存期为9个月（134个月）。无门静脉癌栓组客观缓解率为40. 0%,疾病控制率为85. 0%,而有门静脉癌栓组客观缓解率为5. 9%,疾病控制率为35. 3%,客观缓解率（χ2=4. 1,P=0. 042）及疾病控制率（χ2=7. 65,P=0. 006）在2组...
- 癌,肝细胞 /
- 抗肿瘤联合化疗方案 /
- 门静脉癌栓
Abstract: Objective To investigate the clinical effect of oxaliplatin-based chemotherapy regimen in the treatment of advanced hepatocellular carcinoma ( HCC) with portal vein tumor thrombus. Methods A retrospective analysis was performed for the clinical data of 37 patients who were diagnosed with BCLC stage C advanced HCC in Cancer Center of The First Hospital of Jilin University from December 2013 to June 2017 and received more than 2 courses of systemic chemotherapy with FOLFOX4 regimen. The association between clinical outcome and the presence or absence of portal vein tumor thrombus was analyzed. According to the presence or absence of portal vein tumor thrombus, these patients were divided into non-portal vein tumor thrombus group with 20 patients and portal vein tumor thrombus group with17 patients. The chi-square test and the Fisher's exact test were used for comparison of categorical data between groups, and the Mann-Whitney U test was used for comparison of continuous data between groups. The Kaplan-Meier method was used for survival analysis, and the log-rank test was used for comparison of survival curves between groups. After risk factors were screened out by the univariate analysis, the Cox proportional hazards model was used for multivariate analysis, and hazard ratio ( HR) and 95% confidence interval ( CI) were used.Results For all 37 patients, the median progression-free survival was 4 months ( range 1-30 months) and the median overall survival was 9 months ( range 1-34 months) . There were significant differences between the non-portal vein tumor thrombus group and the portal vein tumor thrombus group in objective response rate ( 40. 0% vs 5. 9%, χ2= 4. 1, P = 0. 042) and disease control rate ( 85. 0% vs35. 3%, χ2= 7. 65, P = 0. 006) . There were also significant differences between the two groups in survival time ( P < 0. 001) and 6-, 12-, and 24-month survival rates ( χ2= 16. 76, 8. 70, and 1. 12, P < 0. 001, P = 0. 003, and P < 0. 001) . Common toxic and side effects included leucopenia, neurotoxicity, gastrointestinal reactions, and liver injury, which were relieved after aggressive management. The Cox multivariate analysis showed that tumor burden ( HR = 0. 045, 95% CI: 0. 009-0. 216, P = 0. 001) and portal vein tumor thrombus ( HR =0. 181, 95% CI: 0. 066-0. 497, P < 0. 001) were independent prognostic factors. Conclusion Patients without portal vein tumor thrombus have a significantly better outcome after chemotherapy than those with portal vein tumor thrombus. Portal vein tumor thrombus is an independent negative prognostic factor for advanced HCC after systemic chemotherapy.
- carcinoma, hepatocellular /
- antineoplastic combined chemotherapy protocols /
- portal vein tumor thrombus

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