摘要
目的研究卡瑞利珠单抗联合阿帕替尼治疗晚期肝癌的效果,分析影响患者预后的相关因素。方法回顾性纳入淮北市人民医院2021年1月至2024年1月收治的晚期肝癌患者82例,均接受卡瑞利珠单抗联合阿帕替尼治疗,观察其治疗结果,并按患者预后进行分组,若随访期间出现转移、复发或者死亡即为预后不良组,未出现转移、复发或者死亡者则为预后良好组,比较两组临床资料和疾病相关特征,将差异有统计学意义的单因素代入Logistic回归方程,得到影响患者预后的相关因素。绘制受试者工作特征(ROC)曲线,分析各因素预测患者预后的价值。结果所有患者经卡瑞利珠单抗联合阿帕替尼治疗后,有效率为25.61%(21/82),临床获益率为79.27%(65/82)。经随访共16例出现转移、复发或者死亡,纳入预后不良组,剩余66例则纳入预后良好组。预后不良组肿瘤长径大于预后良好组[(5.79±1.82)cm比(4.37±1.44)cm],细胞质胸苷激酶1(TK1)、异常凝血酶原Ⅱ(PIVKA-Ⅱ)、成纤维细胞生长因子19(FGF19)、生长分化因子15(GDF15)均明显高于预后良好组[(7.33±2.31)×10^(-12)mol/L比(6.04±2.01)×10^(-12)mol/L、(3.88±1.29)×10^(8)mAU/ml比(2.71±0.90)×10^(8)mAU/ml、(1.54±0.51)×10^(26)ng/L比(1.31±0.32)×10^(26)ng/L、(5.17±1.31)×10^(26)ng/L比(4.43±1.06)×10^(26)ng/L],差异有统计学意义(P<0.05),代入Logistic回归方程,发现上述指标均是影响患者预后的相关因素。ROC曲线分析结果显示,肿瘤长径、TK1、PIVKA-Ⅱ、FGF19、GDF15对应的曲线下面积分别是0.74、0.69、0.98、0.73、0.84,均在预测晚期肝癌预后中存在一定价值。结论卡瑞利珠单抗联合阿帕替尼对晚期肝癌患者的效果较好,但仍有部分患者预后不佳,影响其预后的相关因素较多,例如肿瘤长径、TK1、PIVKA-Ⅱ、FGF19、GDF15等,同时上述因素又可预测患者预后,基于此,临床需引起重视,后续临床工作中应加强对高危患者的监控,以达到改善预后的效果。
ObjectiveTo study the effect of camrelizumab combined with apatinib in advanced hepatocellular carcinoma,and to analyze the related factors affecting patients'prognosis.MethodsEighty-two patients with advanced hepatocellular carcinoma received in Huaibei People's Hospital from January 2021 to January 2024 were retrospectively included,and they were treated with camrelizumab combined with apatinib to observe the results of the treatment.The patients were grouped according to the prognosis of the patients:if metastasis,recurrence or death occurred during the follow-up period,they would be classified into the bad prognosis group,and those who did not have any metastasis,recurrence or death were included into the good prognosis group,and the clinical data and disease-related characteristics of the two groups were compared.The clinical data and disease-related characteristics of the two groups were compared,and the different single factors were substituted into the Logistic regression equation to obtain the relevant factors affecting the prognosis of the patients.The efficacy of the indexes in predicting the prognosis was evaluated by the receiver operating characteristics(ROC)curve.ResultsAll patients were treated with camrelizumab in combination with apatinib with an effective rate of 25.61%(21/82)and a clinical benefit rate of 79.27%(65/82).After follow-up,a total of 16 cases developed metastasis,recurrence or death and were included in the poor prognosis group,while the remaining 66 cases were included in the good prognosis group.The tumor length diameter of the poor prognosis group was larger than that of the good prognosis group:(5.79±1.82)cm vs.(4.37±1.44)cm,and the cytoplasmic thymidine kinase 1(TK1),abnormal plasminogenⅡ(PIVKA-Ⅱ),fibroblast growth factor 19(FGF19)and growth and differentiation factor 15(GDF15)were significantly higher than those of the good prognosis group:(7.33±2.31)×10^(-12)mol/L vs.(6.04±2.01)×10^(-12)mol/L,(3.88±1.29)×10^(8)mAU/ml vs.(2.71±0.90)×10^(8)mAU/ml,(1.54±0.51)×10^(26)ng/L vs.(1.31±0.32)×10^(26)ng/L,(5.17±1.31)×10^(26)ng/L vs.(4.43±1.06)×10^(26)ng/L,the differences were statistically significant(P<0.05),and substituting into Logistic regression equations,it was found that all of the above indexes were correlates affecting patients'prognosis.ROC curve analysis results showed that the area under the curve(AUC)corresponding to tumor length diameter,TK1,PIVKA-Ⅱ,FGF19 and GDF15 were 0.74,0.69,0.98,0.73 and 0.84,respectively,and all of them had some value in predicting the prognosis of advanced hepatocellular carcinoma.ConclusionsThe effect of camrelizumab combined with apatinib in patients with advanced hepatocellular carcinoma is better,but there are still some patients with poor prognosis,and there are more relevant factors affecting their prognosis,such as tumor length diameter,TK1,PIVKA-Ⅱ,FGF19,GDF15,etc.,and at the same time,the above mentioned factors can predict the prognosis of the patients,based on which,the clinic needs to pay attention to it,and the monitoring of high-risk patients should be strengthened in the follow-up clinical work,in order to achieve the effect of improving the prognosis.
作者
郑霁月
孙伟
纵春美
李玉梅
Zheng Jiyue;Sun Wei;Zong Chunmei;Li Yumei(Department of Oncology,Huaibei Peoples Hospital,Huaibei 235099,China)
出处
《中国医师进修杂志》
2026年第3期193-199,共7页
Chinese Journal of Postgraduates of Medicine
基金
安徽省自然科学基金(1708085QH216)。
