张意 文武

【摘要】 目的：探討载药微球经导管动脉化疗栓塞术（DEB-TACE）联合索拉非尼对中晚期肝细胞肝癌（HCC）患者血清肿瘤标志物水平及肝功能的影响。方法：选取2020年6月—2022年6月于贵溪市人民医院就诊的中晚期HCC患者120例，采用随机数字表法分为对照组和研究组，各60例。对照组采用传统肝动脉化疗栓塞联合索拉非尼治疗，研究组采用DEB-TACE联合索拉非尼治疗。对比两组治疗3个月后临床疗效；并对比两组治疗前后血清肿瘤标志物[血管内皮生长因子（vascular endothelial growth factor，VEGF）、癌胚抗原（carcinoembryonic antigen，CEA）、甲胎蛋白（alpha fetoprotein，AFP）]水平及肝功能指标[丙氨酸氨基转移酶（alanine aminotransferase，ALT）、天门冬氨酸氨基转移酶（aspartate aminotransferase，AST）、总胆红素（total bilirubin，TBIL）]水平；对比两组无进展生存期（progressive free survival，PFS）、总生存期（overall survival，OS）及不良反应发生情况。结果：研究组客观缓解率（65.00%）明显高于对照组（40.00%），差异有统计学意义（P<0.05）。与对照组比较，研究组治疗后血清VEGF、CEA及AFP水平均更低，差异均有统计学意义（P<0.05）。与对照组比较，研究组治疗后血清AST、ALT及TBIL水平均更低，差异均有统计学意义（P<0.05）。与对照组比较，研究组PFS及OS均明显延长，差异均有统计学意义（P<0.05）。两组各不良反应发生率比较，差异均无统计学意义（P>0.05）。结论：DEB-TACE联合索拉非尼治疗HCC能显著提高中晚期HCC患者的客观缓解率，延长生存时间，调节血清肿瘤标志物水平，降低肝功能损害。

【关键词】 载药微球经肝动脉化疗栓塞 索拉非尼 肝细胞肝癌 肿瘤标志物 肝功能

Clinical Study of DEB-TACE and Sorafenib in the Treatment of Intermediate and Advanced Hepatocellular Carcinoma/ZHANG Yi， WEN Wu. //Medical Innovation of China， 2024， 21（07）： 00-009

[Abstract] Objective： To investigate the effects of transcatheter arterial chemoembolization with drug-eluting beads （DEB-TACE） combined with Sorafenib on serum tumor markers and liver function in patients with intermediate and advanced hepatocellular carcinoma （HCC）. Method： A total of 120 patients with intermediate and advanced HCC treated in Guixi People's Hospital from June 2020 to June 2022 were selected， divided to the control group and the study group by random number table method， with 60 cases in each group. The control group was treated with conventional transcatheter arterial chemoembolization combined with Sorafenib， and the study group was treated with DEB-TACE combined with Sorafenib. The clinical efficacy of the two groups after 3 months of treatment were compared; the levels of serum tumor markers [vascular endothelial growth factor （VEGF）， carcinoembryonic antigen （CEA）， alpha-fetoprotein （AFP）] and liver function indicators [total bilirubin （TBIL）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）] before and after treatment were compared between the two groups; the progression-free survival （PFS）， overall survival （OS） and occurrence of adverse reactions were compared between the two groups. Result： The objective remission rate of the study group （65.00%） was significantly higher than that of the control group （40.00%）， the difference was statistically significant （P<0.05）. Compared with the control group， the serum VEGF， CEA and AFP levels in the study group after treatment were lower， the differences were statistical significance （P<0.05）. Compared with the control group， the serum AST， ALT and TBIL levels in the study group after treatment were lower， the differences were statistical significance （P<0.05）. Compared with the control group， the PFS and OS of the study group were significantly prolonged， the differences were statistically significant （P<0.05）. The incidences of adverse reactions between the two groups showed no significant differences （P>0.05）. Conclusion： DEB-TACE combined with Sorafenib in the treatment of HCC can significantly improve the objective response rate of patients with intermediate and advanced HCC， prolong survival time， regulate the level of serum tumor markers， and reduce the incidence of liver function impairment.

[Key words] Transcatheter arterial chemoembolization with drug-eluting beads Sorafenib Hepatocellular carcinoma Tumor markers Liver function

First-author's address： General Surgery Department， Guixi People's Hospital， Guixi 335400， China

doi：10.3969/j.issn.1674-4985.2024.07.002

肝细胞肝癌（hepatocellular carcinoma，HCC）是起源于肝细胞的恶性肿瘤，是全球第六大常见癌症，第四大癌症死因。我国是HCC的高发区，约占全球HCC患者的50%以上[1]。HCC通常是一种富血供肿瘤，90%以上的血供来自肝动脉。经导管动脉化疗栓塞术（transcatheter arterial chemoembolization，TACE）是一种利用栓塞剂阻断肿瘤血供，同时在肿瘤局部聚集高浓度的化疗药物，对肿瘤细胞发挥最大限度的杀伤作用的介入治疗方法。根据栓塞剂不同，分为传统TACE（cTACE）和载药微球TACE（DEB-TACE）[2]。索拉非尼属于口服酪氨酸激酶抑制剂，能够抑制肿瘤血管生成和肿瘤细胞增殖。……