摘要
目的:分析动脉化疗栓塞术(transarterial chemoembolization,TACE)联合乐伐替尼与TACE联合索拉非尼治疗HCC合并门静脉癌栓(portal vein tumor thrombus,PVTT)的临床效果与不良反应。方法:纳入116例HCC合并PVTT患者,根据联合药物不同分为观察组(n=56人,TACE联合乐伐替尼)和对照组(n=60人,TACE联合索拉非尼)。卡方检验、独立样本t检验和单因素Mann-Whitney U检验对组间基线资料和不良反应进行分析,Kaplan-Meier法绘制两组总生存期(overall survival,OS)和无复发生存期(recurrence-free survival,RFS)的生存曲线,使用单-多因素逻辑回归对乐伐替尼组进行分层分析,找出影响TACE联合乐伐替尼组患者RFS和OS的危险因素。结果:TACE+乐伐替尼治疗组RFS明显长于TACE+索拉非尼组(3.873 vs 2.977个月,P=0.008),同时观察组OS亦显著优于对照组(10.840 vs 8.925个月,P=0.012)。年龄、Alb、overall diameter和Largest diameter是影响TACE+乐伐替尼组患者RFS的独立危险因素(P<0.05)。年龄、Alb、Child-Pugh分级、ALBI、PVTT程度和AFP是影响该组患者OS的独立危险因素(P<0.05)。在药物不良反应方面,乐伐替尼组患者腹水的发生率较高(P<0.05),索拉非尼组患者上消化道出血和皮疹的发生率较高(P<0.05)。结论:TACE联合乐伐替尼在治疗HCC合并PVTT方面表现出较高安全性,其疗效明显优于TACE联合索拉非尼。
Objective:To analyze the efficacy and adverse reactions of transarterial chemoembolization(TACE)combined with lenvatinib versus TACE combined with sorafenib in the treatment of portal vein tumor thrombus(PVTT)in patients with HCC.Methods:A total of 116 HCC patients with PVTT were included,divided into the observation group(n=56,TACE combined with lenvatinib)and the control group(n=60,TACE combined with sorafenib).Chi-square test,independent samples t-test,and one-factor Mann-Whitney U test were employed for baseline data and adverse reactions analysis between groups.Kaplan-Meier method was used to plot survival curves for OS and RFS in both groups.Single and multiple factor logistic regression analysis was conducted for the lenvatinib group to identify risk factors influencing RFS and OS.Results:The RFS of the TACE+Lenvatinib treatment group is significantly longer than that of the TACE+Sorafenib group(3.873 months vs 2.977 months,P=0.008).At the same time,the OS of the observation group also significantly increased(10.840 months vs 8.925 months,P=0.012).Age,Alb,overall diameter,and largest diameter were identified as independent risk factors affecting RFS in the TACE+Lenvatinib group(P<0.05).Age,Alb,Child-Pugh classification,ALBI score,PVTT severity,and AFP were identified as independent risk factors affecting OS in the same group(P<0.05).Regarding adverse drug reactions,the incidence of ascites was higher in the Lenvatinib group(P<0.05),while upper gastrointestinal bleeding and rash were more prevalent in the sorafenib group(P<0.05).Conclusion:TACE combined with lenvatinib demonstrates high safety and superior efficacy in the treatment of PVTT compared to TACE combined with sorafenib.
作者
周文考
黄灵炎
赵方俐
朱琳
唐慧敏
王明山
李丽珍
陈磊
ZHOU Wenkao;HUANG Lingyan;ZHAO Fangli;ZHU Lin;TANG Huimin;WANG Mingshan;LI Lizhen;CHEN Lei(Xiang'an Hospital of Xiamen University,Fujian Xiamen 361000,China)
出处
《现代肿瘤医学》
2025年第10期1757-1763,共7页
Journal of Modern Oncology
