门静脉癌栓对FOLFOX4方案系统治疗晚期肝细胞癌效果的影响

杨光; 董亚冰; 赵玲玲; 崔国振; 赵恒军; 王楠娅

doi:10.3969/j.issn.1001-5256.2018.10.016

门静脉癌栓对FOLFOX4方案系统治疗晚期肝细胞癌效果的影响

DOI: 10.3969/j.issn.1001-5256.2018.10.016

吉林大学第一医院肿瘤中心

详细信息

中图分类号: R735.7
计量
- 文章访问数: 2118
- HTML全文浏览量: 40
- PDF下载量: 393
- 被引次数: 0
出版历程
- 收稿日期: 2018-03-26
- 出版日期: 2018-10-20

Influence of portal vein tumor thrombus on the clincial effect of FOLFOX4 chemotherapy regimen in treatment of advanced hepatocellular carcinoma

Cancer Center, The First Hospital of Jilin University

摘要

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（130个月）,中位总生存期为9个月（134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...
- 癌,肝细胞 /
- 抗肿瘤联合化疗方案 /
- 门静脉癌栓
Abstract: Objective To investigate the clinical effect of oxaliplatin-based chemotherapy regimen in the treatment of advanced hepatocellular carcinoma ( HCC) with portal vein tumor thrombus. Methods A 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 with17 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.Results For 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% vs35. 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. Conclusion Patients 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.
- carcinoma, hepatocellular /
- antineoplastic combined chemotherapy protocols /
- portal vein tumor thrombus

HTML全文

参考文献(23)

[1]QIN S, CHENG Y, LIANG J, et al.Efficacy and safety of the FOL-FOX4 regimen versus doxorubicin in Chinese patients with advanced hepatocellular carcinoma:A subgroup analysis of the EACH study[J].Oncologist, 2014, 19 (11) :1169-1178.

[2]Global Burden of Disease Liver Cancer Collaboration.The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level results from the Global Burden of Disease Study 2015[J].JAMA Oncol, 2017.[Epub ahead of print]

[3]WANG WQ.Incidence and mortality of malignant tumors in China in 2016[J/CD].J Clin Med Literature:Electronic Edition, 2017, 4 (19) :3604. (in Chinese) 王维琼.2016年中国恶性肿瘤发病和死亡分析[J/CD].临床医药文献杂志:电子版, 2017, 4 (19) :3604.

[4] QIN SK, DONG JH, LU SC, et al.A preliminary report of clinical registry of primary liver cancer in China[R].Xiamen:The 2017CSCO Annual Academic Conference. (in Chinese) 秦叔逵, 董家鸿, 卢实春, 等.中国原发性肝癌临床登记调查初步报告[R].厦门:2017年CSCO学术年会.

[5]National Health and Family Planning Commission of the People's Republic of China.Diagnosis, management, and treatment of hepatocellular carcinoma (V2017) [J].J Clin Hepatol, 2017, 33 (8) :1419-1431. (in Chinese) 中华人民共和国国家卫生和计划生育委员会.原发性肝癌诊疗规范 (2017年版) [J].临床肝胆病杂志, 2017, 33 (8) :1419-1431.

[6]QIN SK, BAI Y, SUN Y, et al.PhaseⅢstudy of oxaliplatin plus5-fluorouracil/leucovorin (FOLFOX4) versus doxorubicin as palliative systemic chemotherapy in advanced HCC in Asian patients.American Society of Clinical Oncology Annual Meeting Chicago[J].J Clin Oncol, 2010, 28 (15 Suppl) :4008.

[7]MENG ZQ, LIU LM, MA X, et al.Prognosis risk factors and therapeutic effect analysis in primary hepatic carcinoma:394 cases report[J].China Oncol, 2007, 17 (8) :628-632. (in Chinese) 孟志强, 刘鲁明, 马鑫, 等.394例原发性肝癌的预后因素与疗效分析[J].中国癌症杂志, 2007, 17 (8) :628-632.

[8] The National Research Cooperative Group for Diagnosis and Treatment of Hepatocellular Carcinoma with Tumor Thrombus.Chinese expert consensus on multidisciplinary diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombus (2016 edition) [J].Chin J Dig Surg, 2016, 15 (5) :411-416. (in Chinese) 全国肝癌合并癌栓诊治研究协作组.肝细胞癌合并门静脉癌栓多学科诊治中国专家共识 (2016年版) [J].中华消化外科杂志, 2016, 15 (5) :411-416.

[9]CHEN W, ZHENG R, BAADE PD, et al.Cancer statistics in China, 2015[J].CA Cancer J Clin, 2016, 66 (2) :115-132.

[10]SHAO HB, MA TC, NIU M, et al.Endovascular placement of iodine-125 seed strand combined with chemoembolization for the treatment of hepatocellular carcinoma with tumor thrombus in portal vein[J].Chin J Med Offic, 2016, 44 (4) :377-381. (in Chinese) 邵海波, 马腾闯, 牛猛, 等.碘125粒子联合肝动脉化疗栓塞术治疗原发性肝癌合并门脉分支癌栓疗效分析[J].临床军医杂志, 2016, 44 (4) :377-381.

[11]CHEN PJ, FURUSE J, HAN KH, et al.Issues and controversies of hepatocellular carcinoma-targeted therapy clinical trials in Asia:experts'opinion[J].Liver Int, 2010, 30 (10) :1427-1438.

[12]XIE B, WANG DH, SPECHLER SJ.Sorafenib for treatment of hepatocellular carcinoma:a systematic review[J].Dig Dis Sci, 2012, 5 (5) :1122-1129.

[13] LLOVET JM, RICCI S, MAZZAFERRO V, et al.Sorafenib in advanced hepatocellular carcinoma[J].N Engl J Med, 2008, 359:378-390.

[14]GU XL, WANG J, SHAN GQ.Clinical study of FOLFOX4 regimen for patients with advanced hepatocellular carcinoma[J].J Mod Oncol, 2014, 22 (9) :2153-2155. (in Chinese) 顾小林, 王娟, 单桂芹.FOLFOX4治疗晚期肝癌的临床研究[J].现代肿瘤医学, 2014, 22 (9) :2153-2155.

[15]QIN SK, CAO MR, QIAN J, et al.Clinical study of FOLFOX regimen for the patients with advanced hepatocellular carcinoma[J].Chin Clin Oncol, 2005, 10 (1) :58-60. (in Chinese) 秦叔逵, 曹梦苒, 钱军, 等.奥沙利铂为主的FOLFOX4方案治疗晚期原发性肝癌[J].临床肿瘤学杂志, 2005, 10 (1) :58-60.

[16]BRUIX J, QIN S, MERLE P, et al.Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE) :A randomised, double-blind, placebo-controlled, phase 3 trial[J].Lancet, 2017, 389 (10064) :56-66.

[17]MELERO I, SANGRO B, YAU TC, et al.Safety and antitumor activity of nivolumab (nivo) in patients (pts) with advanced hepatocellular carcinoma (HCC) :Interim analysis of dose-expansion cohorts from the phase 1/2 CheckMate-040 study[J].J Clin Oncol, 2016, 34 (Suppl 15) :4078.

[18]PETRELLI F, COINU A, BORGONOVO K, et al.Oxaliplatinbased chemotherapy:a new option in advanced hepatocellular carcinoma.a systematic review and pooled analysis[J].Clin Oncol (RColl Radiol) , 2014, 26 (8) :488-496.

[19]HAN K, KIM JH, KO GY, et al.Treatment of hepatocellular carcinoma with portal venous tumor thrombosis:A comprehensive review[J].World J Gastroenterol, 2016, 22 (1) :407-416.

[20]CHEN SQ, SUN JX, SHI J, et al.Difficulties and countermeasures of diagnosis and treatment for hepatocellular carcinoma with portal venous tumor thrombus[J].Zhejiang Med J, 2017, 39 (2) :75-79, 81. (in Chinese) 程树群, 孙居仙, 石洁, 等.肝细胞癌合并门静脉癌栓诊治若干问题[J].浙江医学, 2017, 39 (2) :75-79, 81.

[21]JIANG YB, GUO WX, CHENG SQ.Progress in molecular mechanism of forming portal vein tumor thrombus for hepatocellular carcinoma[J].Chin J Cell Biol, 2017, 39 (2) :244-249. (in Chinese) 蒋亚波, 郭卫星, 程树群.肝细胞癌伴门静脉癌栓发生机制的研究进展[J].中国细胞生物学学报, 2017, 39 (2) :244-249.

[22]YOON SM, LIM YS, WON HJ, et al.Radiotherapy plus transarterial chemoembolization for hepatocellular carcinoma invading the portal vein:Long-term patient outcomes[J].Int J Radiat Oncol Biol Phys, 2012, 82 (5) :2004-2011.

[23]LIU SS.Quality of life after surgical treatment of primary liver cancer and related influencing factors[J].Chin Hepatol, 2017, 22 (2) :146-148. (in Chinese) 刘双双.原发性肝癌手术治疗的生存质量及影响因素分析[J].肝脏, 2017, 22 (2) :146-148.

施引文献

资源附件(0)

访问统计