Effect of sorafenib combined with transcatheter arterial chemoembolization and radiofrequency ablation on the survival of patients with hepatocellular carcinoma
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摘要: 目的分析索拉非尼联合经肝动脉化疗栓塞术(TACE)和射频消融(RFA)治疗肝细胞癌(HCC)患者的生存期及预后影响因素。方法回顾性分析2012年1月-2016年6月首都医科大学附属北京佑安医院收治的,分别接受索拉非尼单药治疗(n=30)、索拉非尼联合TACE(二联疗法,n=70),或者索拉非尼联合TACE和RFA(三联疗法,n=121)治疗的221例HCC患者的中位生存期及其预后影响因素。采用Kaplan-Meier法绘制生存曲线,log-rank检验生存曲线是否有差异,Cox比例风险回归模型进行生存率的影响因素分析;不同疗法治疗患者的Child-Pugh分级和BCLC分期比较,采用Wilcoxon秩和检验分析。结果接受三联疗法治疗患者的中位生存时间,较二联疗法(9. 5个月vs 4. 3个月,χ2=12. 77,P=0. 000 4),或索拉非尼单药治疗组(9. 5个月vs2. 0个月,χ2=16. 69,P <0. 000 1)显著延长。影响疾病进展的危险因素包括患者年龄<60岁,BCLC分期C期,Child-Pugh分级B级、C级,血清AFP> 200 ng/m...Abstract: Objective To analyze the effect of sorafenib combined with transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) on the survival of patients with hepatocellular carcinoma (HCC) and its prognostic factors.Methods A retrospective analysis was performed on 221 HCC patients who received sorafenib alone (group A) , sorafenib plus TACE (group B) , or sorafenib combined with TACE and RFA (group C) in Beijing YouAn Hospital, Capital Medical University, from January 2012 to June 2016 to investigate their median survival and its prognostic factors.The Kaplan-Meier method was used to plot a survival curve, and the log-rank test was used to test whether there was any difference in the survival curve;the Cox proportional-hazards regression model was used to analyze the influencing factors for survival rate;the Wilcoxon rank sum test was used to compare Child-Pugh class and Barcelona Clinic Liver Cancer (BCLC) stage between the patients treated with different therapies.Results Group C had a significantly longer median survival than group B (9.5 months vs 4.3 months, χ2=12.77, P=0.000 4) and group A (9.5 months vs 2.0 months, χ2=16.69, P<0.000 1) .The risk factors for disease progression were age<60 years, BCLC stage C, Child-Pugh class B, Child-Pugh class C, serum alpha-fetoprotein>200 ng/ml, poor tumor differentiation, tumor diameter>5 cm, and intrahepatic tumor with microvascular invasion or extrahepatic spread, as well as absence of sorafenib-related side events (all P<0.05) .Conclusion Sorafenib combined with TACE and RFA can prolong the survival of HCC patients.Age<60 years and severe tumor burden are poor prognostic factors for disease progression in HCC patients.
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[1]LI Z, ZHU JY.An interpretation of diagnosis, management, and treatment of hepatocellular carcinoma (V2017) [J].J Clin Hepatol, 2017, 33 (9) :1655-1657. (in Chinese) 李照, 朱继业.《原发性肝癌诊疗规范 (2017年版) 》解读[J].临床肝胆病杂志, 2017, 33 (9) :1655-1657. [2] TEJEDA-MALDONADO J, GARCIA-JUAREZ I, AGUIRRE-VALADEZ J, et al.Diagnosis and treatment of hepatocellular carcinoma:An update[J].World J Hepatol, 2015, 7 (3) :362-376. [3]LO CM, NGAN H, TSO WK, et al.Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma[J].Hepatology, 2002, 35 (5) :1164-1171. [4]TSOCHATZIS EA, GERMANI G, BURROUGHS AK.Transarterial chemoembolization, transarterial chemotherapy, and intra-arterial chemotherapy for hepatocellular carcinoma treatment[J].Semin Oncol, 2010, 37 (2) :89-93. [5]ZHENG J, SUN B, LIU D, et al.Treatment with transcatheter arterial chemoembolization induces an increase of the L-selectin (low) CXCR3+CD8+T cell subset in patients with hepatocellular carcinoma[J].Onco Targets Ther, 2012, 5:103-109. [6]National Health and Family Planning Commission of the People's Republic of China.Diagnosis, management, and treatment of hepatocellular carcinoma (V2017) [J].J Clin Hepatol, 2017, 33 (8) :1419-1431. (in Chinese) 中华人民共和国国家卫生和计划生育委员会.原发性肝癌诊疗规范 (2017年版) [J].临床肝胆病杂志, 2017, 33 (8) :1419-1431. [7]KUDO M.Radiofrequency ablation for hepatocellular carcinoma:updated review in 2010[J].Oncology, 2010, 78 (Suppl1) :113-124. [8]YADA M, MASUMOTO A, MOTOMURA K, et al.Indicators of sorafenib efficacy in patients with advanced hepatocellular carcinoma[J].World J Gastroenterol, 2014, 20 (35) :12581-12587. [9]LENCIONI R.Loco-regional treatment of hepatocellular carcinoma in the era of molecular targeted therapies[J].Oncology, 2010, 78 (Suppl 1) :107-112. [10]CROCETTI L, BARGELLINI I, CIONI R.Loco-regional treatment of HCC:Current status[J].Clin Radiol, 2017, 72 (8) :626-635. [11]WANG CH, WEY KC, MO LR, et al.Current trends and recent advances in diagnosis, therapy, and prevention of hepatocellular carcinoma[J].Asian Pac J Cancer Prev, 2015, 16 (9) :3595-3604. [12]TEJEDA-MALDONADO J, GARCIA-JUAREZ I, AGUIRRE-VALADEZ J, et al.Diagnosis and treatment of hepatocellular carcinoma:An update[J].World J Hepatol, 2015, 7 (3) :362-376. [13]LEI XF, KE Y, BAO TH, et al.Effect and safety of sorafenib in patients with intermediate hepatocellular carcinoma who received transarterial chemoembolization:A retrospective comparative study[J].World J Clin Cases, 2018, 6 (5) :74-83. [14]ZHANG Y, GAO X, ZHU Y, et al.The dual blockade of METand VEGFR2 signaling demonstrates pronounced inhibition on tumor growth and metastasis of hepatocellular carcinoma[J].J Exp Clin Cancer Res, 2018, 37 (1) :93. [15]BRUIX J, LII C A, LLOVET J.Reply to:"Predictors of sorafenib benefit in patients with hepatocellular carcinoma"[J].JHepatol, 2018, 68 (3) :620-621. [16]BRUIX J, CHENG A L, MEINHARDT G, et al.Prognostic factors and predictors of sorafenib benefit in patients with hepatocellular carcinoma:Analysis of two phase III studies[J].JHepatol, 2017, 67 (5) :999-1008. [17]CHOI GH, SHIM JH, KIM MJ, et al.Sorafenib alone versus sorafenib combined with transarterial chemoembolization for advanced-stage hepatocellular carcinoma:Results of propensity score analyses[J].Radiology, 2013, 269 (2) :603-611. [18]SOHN W, PAIK YH, CHO JY, et al.Sorafenib therapy for hepatocellular carcinoma with extrahepatic spread:Treatment outcome and prognostic factors[J].J Hepatol, 2015, 62 (5) :1112-1121. [19]SAPISOCHIN G, BRUIX J.Reply[J].Hepatology, 2017, 66 (5) :1704-1705. [20]ZHENG SZ, LIU DJ, SUN P, et al.Feasibility and safety of sorafenib treatment in hepatocellular carcinoma patients with spontaneous rupture[J].World J Gastroenterol, 2014, 20 (43) :16275-16281. 期刊类型引用(18)
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