Liu Baojiang, Zhu Xu, Gao Song, Guo Jianhai, Wang Xiaodong, Cao Guang, Zhu Linzhong, Liu Peng, Xu Haifeng, Chen Hui, Zhang Xin, Liu Shaoxing, Kou Fuxin
Key Laboratory of Carcinogenesis and Translational Research [Ministry of Education], Department of Interventional Therapy, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
J Interv Med. 2019 Jul 31;2(2):91-96. doi: 10.1016/j.jimed.2019.07.006. eCollection 2019 May.
To investigate the safety, efficacy, and prognostic factors of hepatic arterial infusion chemotherapy (HAIC) with raltitrexed and oxaliplatin post-transarterial chemoembolization (TACE) for unresectable hepatocellular carcinoma (uHCC).
Thirty-seven patients with uHCC who received HAIC with raltitrexed and oxaliplatin post-TACE between June 2014 and December 2016 at our hospital were recruited. The primary endpoint was overall survival (OS), and secondary endpoint was progression-free survival (PFS). The overall response rate (ORR) was evaluated using the modified Response Evaluation Criteria in Solid Tumors. Toxicity was assessed according to the Common Terminology Criteria for Adverse Events (v4.0). The OS and prognostic factors were analyzed using the Kaplan-Meier method, log-rank test, and Cox regression models.
Three (8.1%) patients achieved complete response, 17 (46.0%) patients achieved partial response, and the ORR was54.0%.The median OS and median PFS were 19.0 months and 12.0 months, respectively. The common toxicities included grade 3-4 increased aspartate aminotransferase levels (8/37,21.6%), grade 1-2 hyperbilirubinemia (75.7%, 28/37), nonspecific abdominal pain and fever, and grade 2-3 thrombocytopenia (18.9%, 7/37); no patients developed grade 3-4 neutropenia. Univariate analysis showed that the tumor diameter (≤50 mm, p = 0.028), Barcelona Clinic Liver Cancer (BCLC) stage (p = 0.012), hepatitis B virus DNA level (p = 0.033), and derived neutrophil-to-lymphocyte ratio (dNLR; derived neutrophils/leukocytes minus neutrophils) (p = 0.003) were predictive factors for prognosis. Multivariate analysis showed that patients with BCLC stage B disease (p = 0.029) and dNLR≤2 before therapy (p = 0.004) had better prognosis.
HAIC with raltitrexed and oxaliplatin post-TACE is a safe and efficacious therapy for patients with uHCC; in particular, those with BCLC stage B and dNLR≤2 have better prognosis.
探讨替吉奥联合奥沙利铂经动脉化疗栓塞术（TACE）后肝动脉灌注化疗（HAIC）治疗不可切除肝细胞癌（uHCC）的安全性、疗效及预后因素。
选取2014年6月至2016年12月在我院接受TACE术后替吉奥联合奥沙利铂HAIC治疗的37例uHCC患者。主要终点为总生存期（OS），次要终点为无进展生存期（PFS）。采用改良实体瘤疗效评价标准评估总缓解率（ORR）。根据不良事件通用术语标准（第4.0版）评估毒性。采用Kaplan-Meier法、对数秩检验和Cox回归模型分析OS及预后因素。
3例（8.1%）患者达到完全缓解，17例（46.0%）患者达到部分缓解，ORR为54.0%。中位OS和中位PFS分别为19.0个月和12.0个月。常见毒性包括3-4级天冬氨酸转氨酶水平升高（8/37，21.6%）、1-2级高胆红素血症（75.7%，28/37）、非特异性腹痛和发热以及2-3级血小板减少（18.9%，7/37）；无患者发生3-4级中性粒细胞减少。单因素分析显示，肿瘤直径（≤50 mm，p = 0.028）、巴塞罗那临床肝癌（BCLC）分期（p = 0.012）、乙型肝炎病毒DNA水平（p = 0.033）和衍生中性粒细胞与淋巴细胞比值（dNLR；衍生中性粒细胞/白细胞减去中性粒细胞）（p = 0.003）是预后的预测因素。多因素分析显示，BCLC B期疾病患者（p = 0.029）和治疗前dNLR≤2的患者（p = 0.004）预后较好。
TACE术后替吉奥联合奥沙利铂HAIC治疗uHCC患者安全有效；特别是BCLC B期和dNLR≤2的患者预后较好。
