解放军医学杂志2023，Vol.48Issue(12)：1420-1426,7.DOI:10.11855/j.issn.0577-7402.1540.2023.0215
SBRT联合卡瑞利珠单抗和阿帕替尼治疗晚期肝细胞癌的疗效及安全性
Efficacy and safety of stereotactic body radiotherapy combined with karelizumab and apatinib in treatment of advanced hepatocellular carcinoma
摘要
Abstract
Objective To investigate the efficacy and safety of stereotactic body radiotherapy(SBRT)combined with camrelizumab and apatinib in treatment of advanced hepatocellular carcinoma(HCC).Methods The clinical data were retrospectively analyzed of 85 patients with advanced HCC treated in the Fifth Affiliated Hospital of Zhengzhou University and People's Hospital of Zhengzhou from January 2019 to September 2021.They were divided into observation group(n=31,SBRT combined with camrelizumab and apatinib)and control group(n=54,treated with camrelizumab and apatinib)according to whether they received SBRT.The propensity score matching(PSM)was used to balance the influence of confounding factors.The objective remission rate(ORR)and disease control rate(DCR)were compared between the two groups.The 6-month overall survival rate,1-year overall survival rate and progression-free survival(PFS)were compared between the two groups by Kaplan-Meier method.The safety of the two groups was evaluated by Common Terminology Criteria for Adverse Events(CTCAE)version 5.0.Results Before PSM,there were significant differences in age(P=0.043),number of extrahepatic metastasis(P=0.028),and previous surgical treatment(P=0.038)between the two groups.After PSM,there was no significant difference in baseline characteristics between the two groups(P>0.05).After PSM,27 cases were included in each groups,and three months after treatment,the ORR in observation group and control group were 66.7%and 29.6%,respectively,showed difference with statistically significant(P=0.006);and the DCR in the both groups were 96.3%and 85.2%respectively,showed no statistically significant difference(P=0.175).There were statistical differences in 6-month overall survival rate(96.3%vs.80.9%,P=0.001),1-year overall survival rate(75.0%vs.61.4%,P=0.034)and median PFS(8 months vs.5 months,P=0.003)between the observation group and control group.Multi-factor Cox regression analysis showed that baseline alpha-fetoprotein(AFP)≥400 ng/ml was an independent risk factor for affecting the survival of patients with advanced HCC(HR>1,P<0.05),while the triple therapy and previous targeted drugs therapy were the protective factors for the survival of patients with advanced HCC(HR<1,P<0.05).In the observation group,4 patients had grade 3 adverse reactions,and the common adverse reactions were dyspepsia(14.8%).One case of grade 3 adverse reactions occurred in control group,and there was no statistically significant difference in the incidence of adverse reactions between the two groups(P=0.639).Conclusion SBRT combined with camrelizumab and apatinib is a safe and effective treatment for advanced HCC with significant clinical effect and controllable adverse reactions.关键词
立体定向放射治疗/卡瑞利珠单抗/阿帕替尼/肝细胞癌/倾向性评分匹配Key words
stereotactic body radiotherapy/camrelizumab/apatinib/hepatocellular carcinoma/propensity score matching分类
医药卫生引用本文复制引用
雷艳文,丁广成,秦德华,郭彦伟,王海霞,张剑,陈家富,罗青竹,郭文静..SBRT联合卡瑞利珠单抗和阿帕替尼治疗晚期肝细胞癌的疗效及安全性[J].解放军医学杂志,2023,48(12):1420-1426,7.基金项目
This work was supported by the National Science and Technology Major Project(2018ZX10303502-001),and the Henan Province Medical Science and Technology Research Program Joint Construction Project(2018020256) 国家科技重大专项课题(2018ZX10303502-001) （2018ZX10303502-001）
河南省医学科技攻关计划联合共建项目(2018020256) （2018020256）
