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门静脉癌栓对FOLFOX4方案系统治疗晚期肝细胞癌效果的影响
Influence of portal vein tumor thrombus on the clincial effect of FOLFOX4 chemotherapy regimen in treatment of advanced hepatocellular carcinoma
文章发布日期:2018年09月10日  来源:  作者:杨光,董亚冰,赵玲玲,等  点击次数:540次  下载次数:46次

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【摘要】:目的探讨含奥沙利铂化疗方案治疗存在门静脉癌栓的晚期肝细胞癌的临床效果。方法回顾性分析2013年12月-2017年6月在吉林大学第一医院肿瘤中心确诊为BCLC C期的肝细胞癌患者的临床资料,所有患者均接受FOLFOX4方案系统化疗2疗程以上。按照是否合并门静脉癌栓分为2组:无门脉癌栓20例,有门静脉癌栓组17例,分析疗效与是否存在门静脉癌的关系。计数资料2组间比较采用 χ2 检验或Fisher 精确检验,计量资料2组间比较采用 Mann Whitney U检验。生存分析采用 Kaplan Meier 估算,组间生存曲线的比较则用 log-rank 检验,用 Cox 比例风险模型进行多变量分析,以风险比(HR)和 95%可信区间(95%CI)表示。结果37例患者中位无进展生存期为4个月(1~30个月),中位总生存期为9个月(1~34个月)。无门静脉癌栓组客观缓解率为40.0%,疾病控制率为85.0%,而有门静脉癌栓组客观缓解率为5.9%,疾病控制率为35.3%,客观缓解率(χ2=4.1,P=0.042)及疾病控制率(χ2=7.65,P=0.006)在2组间差异均有统计学意义。2组患者的生存期(P<0001)和6个月(χ2=16.76,P<0001)、12个月(χ2=8.70,P=0.003)及24个月(χ2=1.12,P<0001)生存率差异均有统计学意义。常见的毒副作用为白细胞减少、神经毒性、消化道反应以及肝损伤,所有毒副反应经积极处理均缓解。Cox多因素分析结果显示,肿瘤负荷(HR=0.045,95%CI:0.009~0.216,P=0.001)及门静脉癌栓(HR=0.181,95%CI:0.066~0.497,P<0.001)是影响疗效的独立预后因素。结论无门静脉癌栓的患者化疗效果要明显优于存在门静脉癌栓的患者,门静脉癌栓是晚期肝细胞癌系统化疗不良预后的独立影响因素。
【Abstract】:ObjectiveTo investigate the clinical effect of oxaliplatin-based chemotherapy regimen in the treatment of advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombus. MethodsA retrospective analysis was performed for the clinical data of 37 patients who were diagnosed with BCLC stage C advanced HCC in Cancer Center of The First Hospital of Jilin University from December 2013 to June 2017 and received more than 2 courses of systemic chemotherapy with FOLFOX4 regimen. The association between clinical outcome and the presence or absence of portal vein tumor thrombus was analyzed. According to the presence or absence of portal vein tumor thrombus, these patients were divided into non-portal vein tumor thrombus group with 20 patients and portal vein tumor thrombus group with 17 patients. The chi-square test and the Fisher’s exact test were used for comparison of categorical data between groups, and the Mann-Whitney U test was used for comparison of continuous data between groups. The Kaplan-Meier method was used for survival analysis, and the log-rank test was used for comparison of survival curves between groups. After risk factors were screened out by the univariate analysis, the Cox proportional hazards model was used for multivariate analysis, and hazard ratio (HR) and 95% confidence interval (CI) were used. ResultsFor all 37 patients, the median progression-free survival was 4 months (range 1-30 months) and the median overall survival was 9 months (range 1-34 months). There were significant differences between the non-portal vein tumor thrombus group and the portal vein tumor thrombus group in objective response rate (40.0% vs 5.9%, χ2=4.1, P=0.042) and disease control rate (85.0% vs 353%, χ2=7.65, P=0.006). There were also significant differences between the two groups in survival time (P<0.001) and 6-, 12-, and 24-month survival rates (χ2=16.76, 8.70, and 1.12, P<0.001, P=0.003, and P<0.001). Common toxic and side effects included leucopenia, neurotoxicity, gastrointestinal reactions, and liver injury, which were relieved after aggressive management. The Cox multivariate analysis showed that tumor burden (HR=0.045, 95%CI: 0.009-0.216, P=0.001) and portal vein tumor thrombus (HR=0.181, 95%CI: 0.066-0.497, P<0.001) were independent prognostic factors. ConclusionPatients without portal vein tumor thrombus have a significantly better outcome after chemotherapy than those with portal vein tumor thrombus. Portal vein tumor thrombus is an independent negative prognostic factor for advanced HCC after systemic chemotherapy.
【关键字】:癌, 肝细胞; 抗肿瘤联合化疗方案; 门静脉癌栓
【Key words】:carcinoma, hepatocellular; antineoplastic combined chemotherapy protocols; portal vein tumor thrombus
【引证本文】:YANG G, DONG YB, ZHAO LL, et al. Influence of portal vein tumor thrombus on the clincial effect of FOLFOX4 chemotherapy regimen in treatment of advanced hepatocellular carcinoma[J]. J Clin Hepatol, 2018, 34(10): 2142-2147. (in Chinese)
杨光, 董亚冰, 赵玲玲, 等. 门静脉癌栓对FOLFOX4方案系统治疗晚期肝细胞癌效果的影响[J]. 临床肝胆病杂志, 2018, 34(10): 2142-2147.

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