洛铂联合三氧化二砷TACE治疗老年原发性肝癌的临床疗效观察

摘要

目的 探讨洛铂联合三氧化二砷(As2O3)TACE治疗老年原发性肝癌的疗效及安全性.方法 将95例肝功能为Child-Pugh A或B级的中晚期及不愿外科手术治疗的早期原发性肝癌老年患者按照不同用药方案分为观察组(n=48)和对照组(n=47),两组均行TACE介入治疗,观察组使用洛铂(40 mg/m2)联合As2O3(10 mg/m2),对照组使用As2O3(10 mg/m2),每间隔6周行1次TACE.评价两组介入治疗的客观有效率(RR)、疾病控制率(DCR)、中位无进展生存期(mPFS)及不良反应发生率.结果 观察组和对照组的RR分别为50.0％、48.9％ (P＞0.05);DCR分别为85.4％、80.9％,差异无统计学意义(P＞0.05),mPFS分别为9.0个月、6.0个月,差异有显著统计学意义(P＜0.001),两组的不良反应主要为恶心呕吐、发热及转氨酶升高等,差异均无统计学意义(P＞0.05).结论 洛铂联合As2O3治疗老年原发性肝癌可延长患者的mPFS,不良反应可耐受,可以是治疗老年原发性肝癌的较好方案,但要将其作为常规用药方案,尚有待大样本随机对照研究进一步证实.%Objective To investigate the clinical efficacy and safety of transcatheter arterial chemoembolization (TACE) by combination use of lobaplatin and arsenic trioxide in treating primary hepatocellular carcinoma (PHC) in elderly patients.Methods Based on the different medication program,a total of 95 PHC patients,whose liver function belonged to Child-Pugh A or B grade (middle-late stage PHC) or who suffered from early-stage PHC and were unwilling to undergo surgical treatment,were divided into the observation group (n=48) and the control group (n=47).TACE was performed in all patients of both groups.Lobaplatin (40 mg/m2) and arsenic trioxide (10 mg/m2) were adopted for patients of the observation group,while arsenic trioxide (10 mg/m2) was employed for patients of the control group.TACE was carried out once every 6 weeks.The objective response rate (ORR),disease control rate (DCR),the median progression free survival time (mPFS) and the incidence of adverse reactions of both groups were analyzed.Results The ORR of the observation group and the control group was 50.0％ and 48.9％ respectively,and the difference was not statistically significant (P＞0.05).The DCR of the observation group and the control group was 85.4％ and 80.9％ respectively,and the difference was not statistically significant (P＞0.05).The mPFS of the study group and the control group was 9 months and 6 months respectively,and the difference was statistically significant (P＜0.001).The main adverse reactions in the two groups were nausea,vomiting,fever,elevation of aminotransferase,etc.,but the differences between the two groups were not statistically significant (P＞ 0.05).Conclusion For the treatment of PHC in elderly patients,TACE by combination use of lobaplatin and arsenic trioxide can prolong mPFS,and the adverse reactions can be well tolerated by patients.This therapeutic regimen may be a better treatment means for PHC in elderly patients.However,large sample randomized and controlled studies are needed to further confirm its curative effect before it can be reliably used as a routine clinical medication regimen.