贝伐单抗联合肝动脉化疗栓塞术对36例晚期原发性肝癌生存预后的影响分析

曾筱怡+邱金宝+陈林

摘 要 目的：探讨贝伐单抗联合肝动脉化疗栓塞术（TACE）治疗晚期原发性肝癌的临床疗效及对生存预后的影响。方法：72例晚期原发性肝癌患者随机分为对照组和观察组各36例。对照组给予TACE治疗，观察组则给予动脉灌注贝伐单抗联合TACE治疗。比较两组患者的临床疗效、不良反应、卡氏生存质量评分以及6、12个月生存率及治疗前后血清甲胎蛋白（AFP）和癌胚抗原（CEA）的水平。结果：观察组治疗后的总有效率（16.67%）和临床获益率（77.78%）显著高于对照组的5.56%和55.56%（P<0.05）；观察组患者治疗后血清AFP （416.52±10.89） mg/L和CEA （254.57±50.72）mg/L水平显著低于对照组的（468.34±11.89） mg/L和（314.56±69.84） mg/L （P<0.05）。观察组治疗后的KPS评分（76.86±6.75）分，显著高于对照组的（72.79±5.83）分（P<0.05）；观察组治疗后6个月的生存率为91.67%，高于对照组的86.11% （P>0.05）。 观察组治疗后12个月的生存率为83.33%，显著高于对照组的61.11% （P<0.05）；两组患者发热、腹痛、黑便、过敏反应和转氨酶升高等不良反应的发生率均无统计学意义。结论：贝伐单抗联合TACE治疗晚期原发性肝癌可提高患者的生存质量，延长患者的生存时间，降低患者血清AFP和CEA的水平，疗效确切，值得应用于临床。

关键词 贝伐单抗 肝动脉化疗栓塞术 原发性肝癌 生存预后

中图分类号：R979.19； R735.7 文献标识码：B 文章编号：1006-1533（2016）19-0020-04

clinical curative effect and survival prognosis of bevacizumab combined with transcatheter arterial chemoembolization in the treatment of 36 cases of advanced primary liver cancer*

CENG Xiaoyi**， QIU Jinbao， CHEN Li（Department of Oncology， The Second Hospital of Pingxiang City， Pingxiang 337000， China）

ABSTRACT Objective： To discuss the clinical curative effect and survival prognosis of bevacizumab combined with transcatheter arterial chemoembolization （TACE） in the treatment of advanced primary liver cancer. Methods： Seventy-two patients with advanced primary liver cancer were randomly divided into an observation group and a control group with 36 cases each. The control group was given TACE conventional treatment while the observation group was given arterial perfusion of bevacizumab besides TACE. The clinical efficacy， adverse reactions， Karnofsky score of quality of life （KPS）， 6 and 12 months survival rate， serum AFP （AFP） and carcinoembryonic antigen （CEA） levels before and after treatment were compared between two groups. Results： The total effective rate and clinical benefit rate were significantly higher in the observation group（16.67% and 16.67%） than in the control group （5.56% and 55.56%） after treatment （P<0.05）. The serum AFP and CEA levels were significantly lower in the observation group [（416.52±10.89） mg/L and （254.57±50.72） mg/L] than in the control group[（468.34±11.89） mg/L and （314.56±69.84） mg/L] after treatment （P<0.05）. The KPS scores were significantly higher in the observation group than in the control group （76.86±6.75 vs 72.79±5.83） （P<0.05）. The survival rates were 91.67% in the observation group and 86.11% in the control group 6 months after treatment， which was higher in the observation but without any statistical significance （P>0.05）， however， those were significantly higher in the observation group than in the control group（83.33% vs 61.11%） 12 months after treatment （P<0.05）. There was no statistical significance in the incidence of adverse reactions such as fever， abdominal pain， black stool， allergic reactions and the elevated transaminase between two groups. Conclusion： Bevacizumab combined with TACE for the treatment of patients with advanced primary liver cancer can improve the quality of survival， extend the survival time of patients， reduce the serum AFP and CEA levels with definite curative effect and worthy of further clinical promotion.

KEY WORDS bevacizumab； transcatheter arterial chemoembolization； primary liver cancer； survival prognosis

原发性肝癌是临床常见的恶性肿瘤之一，具有恶性程度高、预后差、生存率低等特点[1]。原发性肝癌发病隐匿，早期诊断不易发现，绝大多数患者确诊时已到了中晚期。目前，肝动脉化疗栓塞（TACE）是临床用于治疗不能手术切除原发性肝癌患者的首选方式，亦是治疗晚期原发性肝癌患者的标准手段[2]。贝伐单抗是重组的人源化单克隆抗体，能与血管内皮生长因子（VEGF）特异性结合，从而起到抑制肿瘤血管生成的作用[3]。本研究通过贝伐单抗和TACE的联合应用，旨在探讨其治疗晚期原发性肝癌的临床疗效及对患者生存预后的影响，现报道如下。

1 资料与方法

1.1 一般资料

选取2013年1月—2015年1月我院收治的晚期原发性肝癌患者72例，根据随机分组的方法分为对照组和观察组各36例。……