DEB-TACE、放疗联合仑伐替尼或阿帕替尼治疗肝细胞癌合并门静脉癌栓的效果对比

摘要/Abstract

摘要： 目的探讨载药微球-肝动脉插管化疗栓塞术(DEB-TACE)、放疗联合仑伐替尼或阿帕替尼治疗肝细胞癌合并门静脉癌栓的效果。方法将72例肝细胞癌合并门静脉癌栓患者随机分为观察组和对照组(各36例),对照组给予DEB-TACE、放疗联合阿帕替尼治疗;观察组给予DEB-TACE、放疗联合仑伐替尼治疗。治疗3个月后,比较两组的临床疗效、不良反应、血清肝功能生化指标、凝血指标、肿瘤标志物。随访18个月,记录无进展生存期(PFS)和总生存期(OS)。结果观察组和对照组的疾病控制率分别为91.67%、72.22%,观察组疾病控制率高于对照组(P<0.05)。观察组腹泻、尿蛋白升高及高血压的发生率分别为8.33%、5.56%、0.00%,低于对照组(27.78%、22.22%、13.89%,P<0.05)。观察组治疗后凝血酶原活动度(PTA)、甲胎蛋白(AFP)水平分别为(88.71±3.95)%、(210.93±32.08)μg/L,好于对照组[(86.14±6.09)%、(229.41±34.57)μg/L,P<0.05]。观察组的PFS曲线、OS曲线均高于对照组(均P<0.05)。结论 DEB-TACE、放疗联合仑伐替尼或阿帕替尼治疗肝细胞癌合并门静脉癌栓的短期疗效良好,联合仑伐替尼组患者取得的生存获益更高,且更适用于伴有基础肾功能不全及高血压的患者。

关键词: 肝细胞癌, 门静脉癌栓, 载药微球-肝动脉插管化疗栓塞术, 放射治疗, 仑伐替尼, 阿帕替尼

Abstract: Objective To explore the efficacy of drug-eluting bead transarterial chemoembolization (DEB-TACE), radiotherapy combined with lenvatinib or apatinib in the treatment of hepatocellular carcinoma with portal vein tumor thrombosis. Methods 72 patients with hepatocellular carcinoma complicated with portal vein thrombosis were randomly divided into an observation group and a control group, with 36 cases in each group. The control group received DEB-TACE, radiotherapy combined with apatinib, while the observation group received DEB-TACE, radiotherapy combined with lenvatinib. After 3 months of treatment, the clinical efficacy, adverse reactions, serum biochemical indicators of liver function, coagulation indicators, tumor markers were compared between the two groups. An 18-month follow-up was conducted to record the primary endpoints, including progression-free survival (PFS) and overall survival (OS). Results The disease control rates of the observation group and the control group were 91.67% and 72.22%, respectively. The disease control rate was higher in the observation group compared with the control group (P<0.05). The occurrence rates of diarrhea, increased urine protein, and hypertension in the observation group were 8.33%, 5.56%, and 0.00%, respectively, which were lower than those of 27.78%, 22.22%, and 13.89% in the control group (P<0.05). After treatment, the PTA and AFP levels in the observation group were (88.71 ± 3.95)% and (210.93 ± 32.08) μg/L, respectively, which were better than those of (86.14 ± 6.09)% and (229.41 ± 34.57) μg/L in the control group (P<0.05). The PFS and OS curves in the observation group were higher than those in the control group (both P<0.05). Conclusion DEB-TACE combined with radiotherapy and either lenvatinib or apatinib demonstrates good short-term efficacy in the treatment of hepatocellular carcinoma with portal vein tumor thrombosis. Patients treated with the combination of DEB-TACE, radiotherapy, and lenvatinib experience greater survival benefits and the treatment is more suitable for patients with underlying renal insufficiency and hypertension.

Key words: Hepatocellular carcinoma, Portal vein tumor thrombosis, Drug-loaded microsphere transarterial chemoembolization, radiotherapy, Lenvatinib, Apatinib

郑学礼, 李华雨, 赵思祺, 黄平. DEB-TACE、放疗联合仑伐替尼或阿帕替尼治疗肝细胞癌合并门静脉癌栓的效果对比[J]. 肝脏, 2025, 30(11): 1483-1488.

ZHENG Xue-li, LI Hua-yu, ZHAO Si-qi, HUANG Ping. A comparison of the efficacy of DEB-TACE, radiotherapy combined with lenvatinib or apatinib in the treatment of hepatocellular carcinoma with portal vein tumor thrombus[J]. Chinese Hepatolgy, 2025, 30(11): 1483-1488.

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