奥沙利铂联合氟尿嘧啶肝动脉灌注化疗与经肝动脉化疗栓塞/栓塞治疗合并主门静脉癌栓的中晚期肝癌的疗效比较
Hepatic Arterial Infusion Chemotherapy Using Oxaliplatin Plus 5-Fluorouracil Versus Transarterial Chemoembolization/Embolization for the Treatment of Advanced Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombosis.
机构信息
Department of Interventional Radiology, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), 52 Fucheng Road, Haidian District, Beijing, 100142, China.
Department of Hepatic, Biliary and Pancreatic Surgery, Peking University Cancer Hospital and Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, 100142, China.
出版信息
Cardiovasc Intervent Radiol. 2020 Jul;43(7):996-1005. doi: 10.1007/s00270-019-02406-3. Epub 2020 Jan 23.
PURPOSE
To compare the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) to transarterial chemoembolization/embolization (TACE/TAE) for the treatment of advanced hepatocellular carcinoma (HCC) with major portal vein tumor thrombosis (PVTT).
MATERIALS AND METHODS
Forty-six patients with advanced HCC with major PVTT who underwent HAIC or TACE/TAE between April 2013 and April 2017 were included. In the HAIC group (n = 22), oxaliplatin (35-40 mg/m for 2 h) and 5-fluorouracil (600-800 mg/m for 22 h) on days 1-3 every 4 weeks were administered for a maximum of six serial courses. In the TACE/TAE group (n = 24), an emulsion of epirubicin (40-60 mg) and lipiodol was administered followed by particles (cTACE), or particles alone embolization (TAE). Overall survival (OS), tumor response according to mRECIST, progression-free survival (PFS), and adverse events were investigated.
RESULTS
Median OS was 20.8 months in the HAIC group versus 4.0 months in the TACE/TAE group (P < 0.001; hazard ratio [HR], 0.17). The HAIC group showed higher tumor response rates than the TACE/TAE group (59.1% [13/22] vs. 22.7% [5/22]; P = 0.014) and a longer median PFS (9.6 vs. 1.5 months; P < 0.001; HR, 0.09). The Child-Pugh class (P = 0.007) and treatment method (P = 0.002) were independent risk factors of survival. The most frequent grade 3 or worse treatment-related adverse events were liver dysfunction (2 [9.1%] vs. 5 [20.8%]), hematological abnormalities (1 [4.5%] vs. 2 [8.3%]), and fever (1 [4.5%] vs. 4 [16.7%]). One treatment-related death due to acute liver failure occurred 3 days after TACE treatment.
CONCLUSION
HAIC may significantly improve OS and provide better tumor control with mild side effects and preserved liver function in patients with advanced HCC with major PVTT compared to TACE/TAE treatment.
目的
比较肝动脉灌注化疗（HAIC）与经肝动脉化疗栓塞/栓塞（TACE/TAE）治疗伴有主门静脉癌栓（PVTT）的晚期肝细胞癌（HCC）的疗效和安全性。
材料和方法
2013 年 4 月至 2017 年 4 月期间，46 例接受 HAIC 或 TACE/TAE 治疗的伴有主 PVTT 的晚期 HCC 患者被纳入研究。HAIC 组（n=22）中，奥沙利铂（35-40mg/m2，持续 2 小时）和氟尿嘧啶（600-800mg/m2，持续 22 小时）在第 1-3 天，每 4 周为一个疗程，最多进行 6 个疗程。TACE/TAE 组（n=24）中，给予表阿霉素（40-60mg）和碘油乳剂，随后给予微球（cTACE）或单纯粒子栓塞（TAE）。观察总生存期（OS）、根据 mRECIST 评估的肿瘤反应、无进展生存期（PFS）和不良反应。
结果
HAIC 组的中位 OS 为 20.8 个月，而 TACE/TAE 组为 4.0 个月（P<0.001；风险比[HR]，0.17）。HAIC 组的肿瘤反应率高于 TACE/TAE 组（59.1%[13/22]比 22.7%[5/22]；P=0.014），中位 PFS 也更长（9.6 比 1.5 个月；P<0.001；HR，0.09）。Child-Pugh 分级（P=0.007）和治疗方法（P=0.002）是生存的独立危险因素。最常见的 3 级或更高级别的治疗相关不良事件为肝功能异常（2[9.1%]比 5[20.8%]）、血液学异常（1[4.5%]比 2[8.3%]）和发热（1[4.5%]比 4[16.7%]）。1 例患者在 TACE 治疗后 3 天因急性肝衰竭死亡。
结论
与 TACE/TAE 治疗相比，HAIC 可显著提高伴有主 PVTT 的晚期 HCC 患者的 OS，并提供更好的肿瘤控制，且副作用轻微，肝功能得以保留。
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