摘要
目的:探讨阿帕替尼+卡瑞利珠单抗联合低剂量放疗(LDRT)一线治疗晚期肝细胞癌(HCC)的疗效和安全性.方法:回顾性分析我院2020年7月至2021年12月收治的晚期HCC患者的临床数据,分为阿帕替尼+卡瑞利珠单抗组(A+C组,41例)和阿帕替尼+卡瑞利珠单抗联合LDRT组(A+C+LDRT组,45例).A+C组患者口服阿帕替尼250 mg/d,静脉注射卡瑞利珠单抗200 mg/3周;A+C+LDRT组患者在A+C组基础上接受LDRT治疗(20～30 Gy/10 F/2 W).评估两组近期疗效、总生存率、无进展生存率、客观缓解率、疾病控制率和不良事件发生率.结果:A+C+LDRT组中位总生存期及中位无进展生存期长于A+C组(P＜0.05).男性、≤60岁、BCLC分期C期、最大肿瘤直径＞10 cm、肿瘤数目＞3枚、合并门静脉癌栓、合并HBV感染、无肝外转移、甲胎蛋白＞200 ng/ml、残留正常肝体积≥1000 ml的患者更能从阿帕替尼+卡瑞利珠单抗联合LDRT中获益(P＜0.05).两组大多数不良事件属于1～2级,仅恶心呕吐的发生率在A+C+LDRT组中更高(P＜0.05).结论:在晚期HCC患者一线治疗中,与阿帕替尼+卡瑞利珠单抗相比,阿帕替尼+卡瑞利珠单抗联合LDRT可显著改善总生存期和无进展生存期,且不良事件可耐受.
Abstract
Objective:To investigate the therapeutic effect and safety of apatinib plus carilizumab combined with low-dose radiotherapy(LDRT)as first-line treatment for advanced hepatocellular carcinoma(HCC).Methods:A retrospective analysis was conducted on the data of advanced HCC patients admitted to our hospital from July 2020 to December 2021.They were divided into Apatinib+Carilizumab group(A+C group,41 cases)and Apatinib+Carilizumab combined with LDRT group(A+C+LDRT group,45 cases).Patients in the A+C group received oral apatinib 250 mg/d and intravenous carilizumab 200 mg/3 weeks,while patients in the A+C+LDRT group received LDRT(20-30 Gy/10 F/2 W)on the basis of the A+C group.The recent therapeutic effect,overall survival rate,progression free survival rate,objective response rate,disease control rate,and incidence of adverse events were compared between the two groups.Results:The median overall survival and median progression free survival in the A+C+LDRT group were longer than those in the A+C group(P＜0.05).Male,≤60 years old,at BCLC stage C,maximum tumor diameter＞10 cm,number of tumors＞3,accompanied by portal vein tumor thrombus,accompanied by HBV infection,no extrahepatic metastasis,AFP＞200 ng/ml,residual normal liver volume≥1000 ml were factors more likely to benefit from apatinib plus carilizumab combined with LDRT(P＜0.05).Most of the adverse events in the two groups were classified as grade 1-2.Except for nausea and vomiting,there was no statistically significant difference in the incidence of adverse events between the two groups(P＞0.05).Conclusion:In the first-line treatment of advanced HCC patients,compared with apatinib plus carilizumab,apatinib plus carilizumab combined with LDRT can significantly improve overall survival and progression free survival,and has tolerable adverse events.
基金项目
广西壮族自治区卫生与计划生育委员会计划课题(Z2015701)
广西壮族自治区卫生健康委员会自筹经费科研课题(Z-R20221963)
维普
万方数据