Apatinib Combined With Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma and Portal Vein Tumor Thrombus: A Multicenter Retrospective Study
Apatinib Combined With Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma and Portal Vein Tumor Thrombus: A Multicenter Retrospective Study
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阿帕替尼联合经动脉化疗栓塞治疗肝细胞癌合并门静脉癌栓患者的多中心回顾性研究
DOI：
10.1016/j.clinthera.2019.04.036
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发表时间：
2019-08-01
影响因子：
3.2
通讯作者：
Li, Jiaping
中科院分区：
文献类型：
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作者：
Fan, Wenzhe;Yuan, Guosheng;Li, Jiaping
目的：以门静脉肿瘤血栓（PVTT）的位置和范围为主要变量，关注经导管动脉化疗栓塞(TACE) +酪氨酸激酶抑制剂阿帕替尼联合治疗肝细胞癌（HCC）疗效的研究很少。这项多中心、回顾性、对照研究比较了TACE +阿帕替尼和单独TACE治疗HCC和PVTT患者的疗效和耐受性。方法：我们回顾性分析2015年1月至2016年1月期间接受TACE +阿帕替尼或TACE单独治疗的不可切除HCC和PVTT患者的数据。采用Kaplan-Meier法比较TACE +阿帕替尼治疗组与单独TACE治疗组的PVTT类型：门静脉主静脉PVTT （A型）、门静脉一级分支PVTT （B型）、门静脉二级或低阶分支PVTT （C型）。结果：188例患者被纳入分析；85例接受TACE +阿帕替尼治疗，103例接受TACE治疗。在PVTT B型（12.2 vs 7.5个月，P < 0.001）或C型（13.7 vs 7.2个月，P = 0.006）患者中，与单独使用TACE相比，TACE +阿帕替尼的中位生存期显著增加。在单因素和多因素分析中，除了治疗策略和甲胎蛋白外，主PVTT缺失是预测生存的独立因素。发生阿帕替尼相关3级不良事件27例（31.8%）。意义：TACE +阿帕替尼对一阶和低阶门静脉分支有肿瘤血栓的晚期HCC患者可能有潜在的益处。阿帕替尼的不良事件需要在应用期间进行监测，尽管表面上是可控的。(C) 2019由爱思唯尔公司出版。
Purpose: Studies focusing on the effects of combined transcatheter arterial chemoembolization (TACE) + the tyrosine kinase inhibitor apatinib in the treatment of patients with hepatocellular carcinoma (HCC), with the location and extent of portal vein tumor thrombus (PVTT) assessed as the main variable, are rare. This multicenter, retrospective, controlled study was performed to compare the efficacy and tolerability of TACE + apatinib and TACE alone in patients with HCC and PVTT.Methods: We retrospectively analyzed data from patients with nonresectable HCC and PVTT who underwent treatment with TACE + apatinib or TACE alone between January 2015 and January 2016. Outcomes in patients who underwent TACE + apatinib were compared with the outcomes of patients who underwent TACE alone, by using the Kaplan-Meier method, according to PVTT type: PVTT in the main portal vein (type A), PVTT in the first-order portal vein branch (type B), and PVTT in second- or lower-order portal vein branches (type C).Findings: One hundred eighty-eight patients were included in the analysis; 85 underwent treatment with TACE + apatinib and 103 underwent treatment with TACE. TACE + apatinib was associated with a significantly greater median survival compared with TACE alone in patients with PVTT type B (12.2 vs 7.5 months; P < 0.001) or type C (13.7 vs 7.2 months; P = 0.006). Along with treatment strategies and alpha-fetoprotein, the absence of main PVTT was an independent factor predictive of survival on uni- and multivariate analysis. Apatinib-related grade 3 adverse events occurred in 27 patients (31.8%).Implications: TACE + apatinib can be of potential benefit to patients with advanced HCC with tumor thrombus in the first- and lower-order portal vein branches. Adverse events with apatinib need to be monitored during application, despite the manageable appearance. (C) 2019 Published by Elsevier Inc.