CAJ | 학술논문

目的：观察经导管肝动脉化疗栓塞术（TACE）与靶向治疗药相结合治疗中晚期肝细胞癌的疗效和安全性。方法2008年1月至2012年12月我院收治的中晚期肝细胞癌患者60例，均采用TACE治疗，其中37例术后口服索拉非尼（400 mg，2次/d），根据不良反应调整用量，定期复查腹部CT。根据mRECIST标准进行疗效评价，观察患者的肿瘤进展时间和总生存期，并记录索拉非尼不良反应和TACE前后的肝功能变化。结果37例应用TACE联合索拉非尼治疗患者的中位生存期为（13±0.98）m，显著长于23例单纯TACE治疗组[（7.3±1.20）m， P=0.001]，肿瘤进展时间为（7.5±1.21）m，显著长于单纯TACE治疗组[（5±0.62）m，P=0.001]；在随访结束时，联合治疗组疾病控制率为48.6%，显著高于单纯TACE组的17.4%（P＜0.01）；多因素分析显示有无联合应用索拉非尼、有无门脉癌栓、是否抗病毒治疗是显著影响生存时间的风险因素；索拉非尼治疗主要的相关不良反应为手足皮肤反应。结论 TACE联合索拉非尼治疗可延长中晚期肝细胞癌患者的疾病进展时间及总生存期，安全性好。
목적：관찰경도관간동맥화료전새술（TACE）여파향치료약상결합치료중만기간세포암적료효화안전성。방법2008년1월지2012년12월아원수치적중만기간세포암환자60례，균채용TACE치료，기중37례술후구복색랍비니（400 mg，2차/d），근거불량반응조정용량，정기복사복부CT。근거mRECIST표준진행료효평개，관찰환자적종류진전시간화총생존기，병기록색랍비니불량반응화TACE전후적간공능변화。결과37례응용TACE연합색랍비니치료환자적중위생존기위（13±0.98）m，현저장우23례단순TACE치료조[（7.3±1.20）m， P=0.001]，종류진전시간위（7.5±1.21）m，현저장우단순TACE치료조[（5±0.62）m，P=0.001]；재수방결속시，연합치료조질병공제솔위48.6%，현저고우단순TACE조적17.4%（P＜0.01）；다인소분석현시유무연합응용색랍비니、유무문맥암전、시부항병독치료시현저영향생존시간적풍험인소；색랍비니치료주요적상관불량반응위수족피부반응。결론 TACE연합색랍비니치료가연장중만기간세포암환자적질병진전시간급총생존기，안전성호。
Objective To observe the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with targeted therapy for advanced hepatocellular carcinoma. Methods From Jan. 2008,to Dec. 2012,60 cases of advanced hepatocellular carcinoma received TACE,among them,37 cases were treated with so-rafenib after TACE,at a dose of 400 mg,twice a day (the dosage was adjusted according to the side effect). Ab-dominal CT scans were regularly performed and treatment efficacy was evaluated according to the modified RE-CIST. The side effect of sorafenib was recorded,so was the liver function before and after TACE. Results In 37 patients received combined treatment (TACE plus sorafenib) and 23 patients received TACE alone,the median overall survival time were (13±0.98) months and (5±0.62) months,respectively (P=0.001),the time to progression were (7.5±1.21) months and (5±0.62) months,respectively (P=0.001),and at the end of followed-up,the disease control rate were 48.6% and 17.4% in the two groups,respectively (P<0.01);The multivariate analysis showed that the risk factors for death were without combination of sorafenib and antiviral therapy,and the presence of portal vein tumor thrombus. The main side effect of sorafenib was hand-foot skin reaction. Conclusion TACE combined with sorafenib has prolonged time to disease progression and overall survival time in patients with advanced hepa-tocellular carcinoma with relatively good safety.