王春艳+吴斌+兰川+邓大炜+张光年+冷政伟+李建水

[摘要] 目的 评估经导管肝动脉化疗栓塞术（TACE）与TACE联合索拉非尼治疗晚期肝细胞癌的效果。 方法 回顾性分析2012年1月～2016年1月在川北医学院附属医院住院的晚期肝细胞癌患者88例的临床资料，将患者分为TACE组和TACE+索拉非尼组（联合组），每组44例。比较两组疾病控制率、不良反应发生率、半年生存率、1年生存率。 结果 联合组疾病控制率为54.5%，高于TACE组（29.5%），差异有统计学意义（P < 0.05）；联合组不良反应发生率为81.8%，TACE组不良反应发生率为84.1%，差异无统计学意义（P > 0.05）；联合组半年生存率、1年生存率分别为59.1%、47.7%，均明显高于TACE组（36.4%、25.0%），差异均有统计学意义（P < 0.05）。 结论 TACE联合索拉非尼治疗晚期肝细胞癌是一种可行的治疗方式，疗效较好，患者远期生存期得到延长，且耐受良好，值得临床推广。

[关键词] 经导管肝动脉化疗栓塞术；索拉非尼；晚期肝细胞癌；疗效

[中图分类号] R735.7 [文献标识码] A [文章编号] 1673-7210（2017）05（b）-0077-03

[Abstract] Objective To assess the therapeutic effect of transcatheter arterial chemoembolization （TACE） combined with Sorafenib in the treatment of advanced hepatocellular carcinoma. Methods The clinical data of 88 patients with advanced hepatocellular carcinoma hospitalized in the Affiliated Hospital of North Sichuan Medical College from January 2012 to January 2016 was analyzed retrospectively. The patients were divided into TACE group and TACE + Sorafenib group （combined group）， with 44 cases in each group. The disease control rate， incidence of adverse reactions， half-year survival rate， one-year survival rate of the two groups were analyzed. Results The disease control rate of combined group was 54.5%， which was higher than that of TACE group （29.5%）， the difference was statistically significant （P < 0.05）； the incidence of adverse reactions in combined group was 81.8%， which of TACE group was 84.1%， there was no significant difference between the two groups （P > 0.05）. The half-year survival rate and one-year survival rate in combined group was 59.1%， 47.7% respectively， which was significantly higher than those of TACE group （36.4%， 25.0%）， the differences were all statistically significant （all P < 0.05）. Conclusion TACE combined with Sofafenib in the treatment of advanced hepatocellular carcinoma is feasible， the therapeutic effect is good， the long-term lifetime is prolonged， the tolerance is well， which is worthy of clinical promotion.

[Key words] Transcatheter arterial chemoembolization； Sorafenib； Advanced hepatocellular carcinoma； Effect

肝細胞癌（HCC）发病率和病死率在我国恶性肿瘤中排名第四，居消化系统肿瘤第三位[1]。晚期HCC患者特别是伴有严重腹水、黄疸、肝功能C级的，已经失去了根治性手术机会，缺乏有效的治疗手段[2]。经导管肝动脉化疗栓塞术（TACE）作为晚期HCC重要的治疗手段被广泛应用于临床，可延缓肿瘤进展，明显延长患者的生存期[3-4]。索拉非尼是一种多激酶抑制剂，可抑制血管生成和促凋亡，晚期HCC服用索拉非尼也明显获益。但TACE联合索拉非尼治疗晚期HCC患者的效果是否优于单一TACE治疗的报道很少。本研究观察晚期HCC患者行TACE或TACE联合索拉非尼治疗的临床效果。现报道如下：

1 资料与方法

1.1 一般资料

回顾性分析2012年1月～2016年1月在川北医学院附属医院住院的HCC患者，共88例。所有患者均经病理活检确诊为HCC。肿瘤病灶不超过4个，甲胎蛋白>400 ng/mL，肿瘤TNM分期为Ⅲ b或Ⅳa期，Child-pugh分级为B～C级，美国东部肿瘤协作组（ECOG）评分0～2分。……