替吉奥联合TACE治疗BCLCB期原发性肝癌疗效分析

摘要

Objective:To compare TACE alone and in combination with oral S-1 in the treatment of BCLC B stage hepatocellular carcinoma(HCC)and observe tumor response,TTP and adverse effects.Methods:According to different therapeutic regimens,fifty-four patients with intermediate HCC were enrolled into two groups:TACE plus S- 1 (group A),TACE (group B).Based on " Up to 7" criteria and Child-Pugh score,four sub-stages of Barcelo-na Clinic Liver Cancer (BCLC)intermediate hepatocellular carcinoma (HCC)were proposed.Thus,patients of both groups were classified into four sub-stages as AB1-AB4 and BB1-BB4.The efficacy and TTP of each patient were detected.Results:In group A,the objective response rate (ORR )was 68 .0 % ,the disease control rate(DCR) was 92.0% and the median time to progression(TTP)was 6.8 months.However,in group B,the ORR was 51.7%,the DCR was 79.3% and the TTP was 4.2 months.Patients in group A achieved better ORR and DCR,but neither a-chieve significant difference (P > 0.05).However,patients in the group A had a significantly longer mTTP than patientsin group B(P = 0.035).The result of subgroup analyses turned out that patients who exceed " Up to 7" showed a lon-ger mTTP in group A when compared to group B.The toxicity was tolerable in both groups.Multivariate analysis showed that tumor response and " Up to 7" were independent prognostic factors of TTP.Conclusion:This study repor-ted the efficacy and safety of TACE in combination with oral S-1 in BCLC B stage hepatocellular carcinoma.The re-sults suggest that the combination therapy has better efficacy and the toxicity is tolerable.The combination manage-ment seems to be an appropriate option for the treatment of patients with intermediate hepatocellular carcinoma,espe-cially whose target lesions exceed " Up to 7" .%目的:观察BCLC B期肝癌患者替吉奥联合TACE方案近期疗效、TTP(至疾病进展时间)及毒副作用,并与单纯TACE治疗对照.为BCLC B期肝癌患者探索一种更好的治疗方案.方法:54例患者根据治疗方案不同分为TACE联合替吉奥组(A组)和单纯TACE组(B组).并根据Bolondi L等的评分标准分别将A组患者分为AB1-AB4亚组(分别对应于BCLC B1-B4期),B组患者分为BB1-BB4亚组(分别对应于BCLC B1-B4期).观察两组患者的近期有效率及TTP.结果:A组有效率(ORR)为68.0%,B组ORR为51.7%,A组疾病控制率(DCR)为92.0%,B组DCR为79.3%,A组mTTP为6.8个月,B组mTTP为4.2个月.其中A组患者ORR及DCR较B组患者均有受益趋势,但结果无统计学差异(P>0.05),A组mTTP较B组明显延长(P=0.035),亚组分析提示A(B2-B4)与B(B2-B4)期患者相比较,mTTP显著延长,差异有统计学意义(P=0.044).治疗相关不良反应可耐受.多因素分析显示影响TTP的因素包括近期疗效(DCR)和"Up to 7"标准.结论:替吉奥联合TACE治疗BCLC B期原发性肝癌疗效好,不良反应少,可以显著延长超过"Up to 7"范围的肝癌患者的TTP.