Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis
Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis
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DOI：
10.3748/wjg.v19.i29.4679
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发表时间：
2013-08-07
影响因子：
4.3
通讯作者：
Yoon, Seung Kew
中科院分区：
文献类型：
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作者：
Song, Do Seon;Bae, Si Hyun;Yoon, Seung Kew
目的：方法：对50例肝癌合并门静脉癌栓（PVTT）患者采用皮下植入式输液港行肝动脉灌注化疗（HAIC），观察其疗效及预后。表阿霉素-顺铂-5-氟尿嘧啶（ECF）化疗方案为：表阿霉素35 mg/m2，第1天;顺铂60 mg/m2，第2天; 5-氟尿嘧啶500 mg/m2，第1 ~ 3天。结果：50例患者中有3例（6%）完全缓解（CR），13例（26%）部分缓解（PR），22例（44%）病情稳定（SD）。中位生存期和进展时间分别为7个月和2个月。HAIC治疗2个周期后，CR 1例（2%），PR 10例（20%），SD 26例（52%）。显著的治疗前预后因素是肿瘤体积< 400 cm 3（P = 0.01）和维生素K缺乏或拮抗剂（PIVKA）-II诱导的蛋白水平正常（P = 0.022）。治疗2个周期后，疾病控制（CR + PR + SD）（P = 0.001）、PVTT缓解（P = 0.003）和甲胎蛋白下降超过50%（P = 0.02）是生存的独立因素。HAIC期间的客观缓解（CR + PR）、疾病控制、PVTT缓解和联合治疗也是重要的预后因素。结论：HAIC可能是治疗肿瘤< 400 cm（3）且预后良好的晚期肝癌伴PVTT患者的有效治疗方式。(C)2013年百世登。All rights reserved.
AIM: To evaluate the prognostic factors and efficacy of hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis.METHODS: Fifty hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) were treated using hepatic arterial infusion chemotherapy (HAIC) via a subcutaneously implanted port. The epirubicin-cisplatin-5-fluorouracil (ECF) chemotherapeutic regimen consisted of 35 mg/m(2) epirubicin on day 1, 60 mg/m(2) cisplatin for 2 h on day 2, and 500 mg/m(2) 5-fluorouracil for 5 h on days 1-3. The treatments were repeated every 3 or 4 wk.RESULTS: Three (6%) of the 50 patients achieved a complete response (CR), 13 (26%) showed partial responses (PR), and 22 (44%) had stable disease (SD). The median survival and time to progression were 7 and 2 mo, respectively. After 2 cycles of HAIC, CR was achieved in 1 patient (2%), PR in 10 patients (20%) and SD in 26 patients (52%). Significant pre-treatment prognostic factors were a tumor volume of < 400 cm(3) (P = 0.01) and normal levels of protein induced by vitamin K absence or antagonist (PIVKA)-II (P = 0.022). After 2 cycles of treatment, disease control (CR + PR + SD) (P = 0.001), PVTT response (P = 0.003) and alpha-fetoprotein reduction of over 50% (P = 0.02) were independent factors for survival. Objective response (CR + PR), disease control, PVTT response, and combination therapy during the HAIC were also significant prognostic factors. Adverse events were tolerable and successfully managed.CONCLUSION: HAIC may be an effective treatment modality for advanced HCC with PVTT in patients with tumors < 400 cm(3) and good prognostic factors. (C) 2013 Baishideng. All rights reserved.