肝动脉插管化疗栓塞术+仑伐替尼+程序性死亡受体1联合治疗对不可切除肝癌的影响

Effect of TACE plus lenvatinib and PD-1 combination therapy on unresectable hepatocellular carcinoma

摘要:

目的 探索肝动脉插管化疗栓塞术（TACE）+仑伐替尼+程序性死亡受体1（PD-1）单抗联合治疗对不可切除肝癌患者的疗效及免疫功能的影响。方法 回顾性分析2021年8月至2023年3月在孝感市中心医院被临床诊断为肝癌晚期患者50例的临床资料，根据治疗方案分为观察组25例（接受TACE+仑伐替尼+PD-1单抗治疗，以下称“三联疗法”），对照组25例（接受TACE+仑伐替尼，以下称“两联疗法”）。比较两组患者的疗效、生存情况以及免疫功能指标。结果 两组患者的一般资料指标比较差异均无统计学意义（P>0.05）。单因素回归分析显示治疗方案及门静脉癌栓与肝癌患者的预后相关，多因素回归分析显示治疗方案及门静脉癌栓是肝癌预后的独立影响因素。观察组的客观缓解率（ORR）也优于对照组（36% vs. 16%，P<0.001）。观察组对不可切除肝癌患者的免疫调节功能强于对照组。观察组的中位总生存期（OS）（19.80个月 vs. 16.10个月，P=0.035）与中位无进展生存期（PFS）（10.10个月 vs. 6.70个月，P=0.041）均优于对照组。结论 本研究结果显示三联疗法的疗效优于两联疗法，可延长不可切除肝癌患者的OS和PFS，对此类患者免疫功能的影响较小，可有效改善患者预后，也为肝癌的治疗提供了新的思路以及理论依据。

关键词:肝动脉化疗栓塞;仑伐替尼;程序性死亡受体1;不可切除肝癌;免疫

Abstract:

Objective To explore the effects of transcatheter arterial chemoembolization (TACE) plus lenvatinib and PD-1 monoclonal antibody combination therapy on the efficacy and immune function of patients with unresectable hepatocellular carcinoma.Methods The clinical data of 50 patients who were clinically diagnosed with advanced hepatocellular carcinoma in Xiaogan Central Hospital from August 2021 to March 2023 were retrospectively analyzed. The patients were divided into 25 cases in the observation group (treated with TACE plus lenvatinib and PD-1 monoclonal antibody, hereinafter referred to as the "triple therapy") and 25 cases in the control group (treated with TACE plus lenvatinib, hereinafter referred to as the "double therapy") according to the treatment plan. The efficacy, survival and immune function indexes of the two groups were compared.Results There was no statistically significant difference between the general information indexes of the two groups of patients. Univariate regression analysis showed that treatment regimen and portal vein thrombosis were associated with the prognosis of patients with hepatocellular carcinoma, and multivariate regression analysis showed that treatment regimen and portal vein thrombosis were independent influences on the prognosis of hepatocellular carcinoma. The objective response rate (ORR) of the observation group was also better than that of the control group (36% vs. 16%, P<0.001). The observation group had a stronger immunomodulatory function than the control group in patients with unresectable hepatocellular carcinoma. The median overall survival (OS) (19.80 months vs. 16.10 months, P=0.035) and median progression-free survival (PFS) (10.10 months vs. 6.70 months, P=0.041) were better in the observation group than in the control group.Conclusion The results of this study show that triple therapy has better efficacy than double therapy, prolongs the overall survival and progression-free survival of patients with unresectable hepatocellular carcinoma, has less effect on the immune function of such patients, effectively improves the prognosis of patients, and also provides a new idea as well as theoretical basis for the treatment of hepatocellular carcinoma.

Key words:transcatheter arterial chemoembolization;lenvatinib;PD-1;unresectable liver cancer;immune