阿帕替尼联合肝动脉化疗栓塞术的抗肝癌疗效及对肿瘤血管再生的影响
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摘要
目的:探索阿帕替尼联合肝动脉化疗栓塞术(TACE)在不可手术切除的中晚期肝癌中的应用价值。方法:选取59例2017年3月至2019年1月间在丽水市中心医院就诊的肝癌患者59例,所有患者均行TACE治疗,根据有无服用阿帕替尼分为阿帕替尼联合TACE组(联合组,28例)和TACE组(31例),治疗3个月后,观察并比较2组患者的肿瘤反应情况,同时,比较治疗前后血清中血管内皮生长因子(VEGF)和人半胱氨酰天冬氨酸蛋白酶8(caspase-8)的变化情况,明确阿帕替尼联合TACE的抗肝癌疗效。结果:联合组的总有效率为71.43%,TACE组的总有效率为45.16%,联合组的总有效率显著高于TACE组(P<0.05);联合组和TACE组治疗前的VEGF水平分别为(122.99±13.10)pg/mL和(120.36±13.86)pg/mL,2组间差异无统计学意义(P>0.05),治疗后分别为(91.49±8.65)pg/mL和(116.89±10.95)pg/mL,均低于治疗前(P<0.01),且联合组显著低于TACE组(P<0.01);联合组和TACE组治疗前的caspase-8水平分别为(83.68±9.21)pg/mL和(82.87±12.01)pg/mL,2组间差异无统计学意义(P>0.05);治疗后分别为(105.55±7.25)pg/mL和(86.57±7.52)pg/mL,均高于治疗前(P<0.01),且联合组明显高于TACE组(P<0.01)。结论:阿帕替尼联合TACE治疗不可手术切除的中晚期肝癌可有效抑制肿瘤血管再生,提高疾病控制效果。
Objective: To explore the value of apatinib combined with transcatheter arterial chemoembolization(TACE) in the treatment of unresectable advanced hepatocellular carcinoma(HCC). Methods: A retrospective study of 59 patients with HCC who were admitted to Lishui Central Hospital from March 2017 to January 2019. All patients underwent TACE and were divided into apatinib combined with TACE group(combined group, 28 cases) and TACE group(31 cases) according to the presence or absence of apatinib. After 3 months of treatment, the tumor responses of the two groups were observed and compared, and the changes in serum vascular endothelial growth factor(VEGF) and caspase-8 before and after treatment were compared, so as to clarify the anti-liver cancer efficacy of apatinib combined with TACE. Results: The total efficacy rate was 71.43% in the combined group, significantly higher than 45.16% in the TACE group(P<0.05). The VEGF levels before treatment in the combination group and the TACE group were(122.99±13.10) pg/mL and(120.36±13.86) pg/mL,respectively. There was no significant difference between the two groups(P>0.05). After treatment, they were(91.49±8.65) pg/mL and(116.89±10.95) pg/mL which were lower than before treatment(P<0.01), and the levels in the combination group was significantly lower than that in the TACE group(P<0.01). The levels of caspase-8 before treatment in the combination group and the TACE group were(83.68±9.21) pg/mL and(82.87±12.01) pg/mL, respectively. There was no significant difference between the two groups(P>0.05). After treatment, they were(105.55±7.25) pg/mL and(86.57±7.52) pg/mL, which were higher than before treatment(P<0.01), and the levels in the combination group was significantly higher than that in the TACE group(P<0.01). Conclusion:Apatinib combined with TACE can effectively inhibit tumor angiogenesisand to improve disease control in the treatment of unresectable advanced hepatocellular carcinoma.
Objective: To explore the value of apatinib combined with transcatheter arterial chemoembolization(TACE) in the treatment of unresectable advanced hepatocellular carcinoma(HCC). Methods: A retrospective study of 59 patients with HCC who were admitted to Lishui Central Hospital from March 2017 to January 2019. All patients underwent TACE and were divided into apatinib combined with TACE group(combined group, 28 cases) and TACE group(31 cases) according to the presence or absence of apatinib. After 3 months of treatment, the tumor responses of the two groups were observed and compared, and the changes in serum vascular endothelial growth factor(VEGF) and caspase-8 before and after treatment were compared, so as to clarify the anti-liver cancer efficacy of apatinib combined with TACE. Results: The total efficacy rate was 71.43% in the combined group, significantly higher than 45.16% in the TACE group(P<0.05). The VEGF levels before treatment in the combination group and the TACE group were(122.99±13.10) pg/mL and(120.36±13.86) pg/mL,respectively. There was no significant difference between the two groups(P>0.05). After treatment, they were(91.49±8.65) pg/mL and(116.89±10.95) pg/mL which were lower than before treatment(P<0.01), and the levels in the combination group was significantly lower than that in the TACE group(P<0.01). The levels of caspase-8 before treatment in the combination group and the TACE group were(83.68±9.21) pg/mL and(82.87±12.01) pg/mL, respectively. There was no significant difference between the two groups(P>0.05). After treatment, they were(105.55±7.25) pg/mL and(86.57±7.52) pg/mL, which were higher than before treatment(P<0.01), and the levels in the combination group was significantly higher than that in the TACE group(P<0.01). Conclusion:Apatinib combined with TACE can effectively inhibit tumor angiogenesisand to improve disease control in the treatment of unresectable advanced hepatocellular carcinoma.
引文
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[14]林岩松,王宸,李慧,等.甲磺酸阿帕替尼治疗进展性碘难治性甲状腺癌的短期疗效及安全性初步报告[J].中国癌症杂志,2016,26(9):721-726.
[15]姚艺玮,何义富,胡冰,等.阿帕替尼治疗晚期胃癌临床观察[J].中华肿瘤防治杂志,2017,24(6):389-393.
[16]姜增凯,叶晓歌,陈琴华.阿帕替尼对肝癌细胞增殖和迁移能力的影响研究[J].中国临床药理学杂志,2016,32(15):1422-1424.
[17]李威,满文玲,郭欢庆,等.TACE联合甲磺酸阿帕替尼治疗中晚期肝癌的临床研究[J].肿瘤药学,2017,7(1):74-78.
[2]SHEN Y,GUO H,WU T,et al.Lower education and household income contribute to advanced disease,less treatment received and poorer prognosis in patients with hepatocellular carcinoma[J].J Cancer,2017,8(15):3070-3077.
[3]赵建国,王挺,赵中伟,等.重组人血管内皮抑制素联合肝动脉栓塞化疗术治疗中晚期原发性肝癌的临床研究[J].温州医科大学学报,2016,46(4):245-248.
[4]庄磊,魏永刚,宋其同,等.BCLC B期肝癌术后行索拉非尼治疗的疗效分析[J].温州医科大学学报,2015,45(12):929-931.
[5]匡远黎,王郑,杨志亮,等.经肝动脉化疗栓塞联合射频消融术对中晚期原发性肝癌的近期疗效分析[J].肝胆胰外科杂志,2017,29(5):363-367.
[6]祝普利,王德盛,田德福.肝动脉化疗栓塞联合射频消融治疗原发性肝癌124例临床观察[J].肝胆胰外科杂志,2018,30(1):1-4.
[7]ZHANG R,SHEN L,ZHAO L,et al.Combined transarterial chemoembolization and microwave ablation versus transarterial chemoembolization in BCLC stage B hepatocellular carcinoma[J].Diagn Interv Radiol,2018,24(4):219-224.
[8]VARGHESE J,KEDARISETTY C,VENKATARAMANJ,et al.Combination of TACE and sorafenib improves outcomes in BCLC stages B/C of hepatocellular carcinoma:a single centre experience[J].Ann Hepatol,2017,16(2):247-254.
[9]JIN H,LIAO J,XU L,et al.Apatinib radiosensitizes hepatocellular carcinoma in vitro and in vivo[J].Cancer Biol Med,2018,15(suppl 1):20.
[10]YANG C,QIN S.Apatinib targets both tumor and endothelial cells in hepatocellular carcinoma[J].Cancer Med,2018,7(9):4570-4583.
[11]李照,朱继业.《原发性肝癌诊疗规范(2017年版)》解读[J].临床肝胆病杂志,2017,33(9):1655-1657.
[12]杨建军,党冬梅.TACE治疗肝癌患者30例疗效分析[J].临床医学研究与实践,2017,2(17):16-18.
[13]涂艳,彭枫.阿帕替尼治疗恶性肿瘤的临床研究进展[J].中国肿瘤临床,2016,43(12):545-548.
[14]林岩松,王宸,李慧,等.甲磺酸阿帕替尼治疗进展性碘难治性甲状腺癌的短期疗效及安全性初步报告[J].中国癌症杂志,2016,26(9):721-726.
[15]姚艺玮,何义富,胡冰,等.阿帕替尼治疗晚期胃癌临床观察[J].中华肿瘤防治杂志,2017,24(6):389-393.
[16]姜增凯,叶晓歌,陈琴华.阿帕替尼对肝癌细胞增殖和迁移能力的影响研究[J].中国临床药理学杂志,2016,32(15):1422-1424.
[17]李威,满文玲,郭欢庆,等.TACE联合甲磺酸阿帕替尼治疗中晚期肝癌的临床研究[J].肿瘤药学,2017,7(1):74-78.