摘要
目的探讨Ⅲa~Ⅲb肝细胞癌患者TACE联合小剂量阿帕替尼和卡瑞利珠单抗治疗的近期效果、生存差异以及对外周血T淋巴细胞亚群指标的影响。方法选取本院收治的76例CNLCⅢa~Ⅲb肝癌患者,根据是否联合使用小剂量阿帕替尼和卡瑞利珠单抗治疗将其分为联合组和对照组,其中联合组41例,对照组35例,对照组给予常规TACE治疗,联合组在TACE治疗的基础上给予口服小剂量阿帕替尼(250 mg/125 mg/每日交替服药)和注射卡瑞利珠单抗(200 mg/3周)治疗。比较两组近期疗效、外周血T淋巴细胞亚群计数水平变化以及生存差异。结果1)治疗3、6个月后联合组客观缓解率(ORR)为48.78%、43.90%,对照组ORR为25.71%、20,00%;联合组疾病控制率(DCR)为87.70%、78.05%,对照组DCR为68.60%、48.57%。联合组ORR和DCR显著高于对照组(P<0.05);2)治疗前两组外周血CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞计数及CD4^(+)/CD8^(+)之间差异均无统计学意义(P>0.05);治疗后联合组T淋巴细胞各亚群计数及CD4^(+)/CD8^(+)较治疗前明显升高(P<0.05);治疗后各阶段联合组T淋巴细胞各亚群计数水平及CD4^(+)/CD8^(+)均高于对照组(P<0.05);3)联合组较对照组中位OS和中位PFS均有显著提高(P<0.05);4)小剂量阿帕替尼相关不良反应发生率低,均低于3级;卡瑞利珠相关不良反应发生率较高,除2例(5.71%)患者出现免疫相关性肺损伤外,其余均低于3级。结论TACE联合小剂量阿帕替尼和卡瑞利珠单抗治疗Ⅲ期肝细胞癌患者疗效明显优于单纯TACE,不良反应可耐受。联合治疗可有效提高患者外周血T淋巴细胞亚群指标水平,改善机体免疫环境,控制病情发展。
Objective To investigate the short-term effect,survival difference and the effect of TACE combined with low-dose apatinib and carrelizumab on peripheral blood T lymphocyte subsets in patients withⅢa~Ⅲb hepatocellular carcinoma.Methods A total of 76 patients with CNLCⅢa~Ⅲb HCC treated in our hospital from September 2019 to September 2021 were retrospectively analyzed and divided into the combined and control groups according to whether they were treated with low-dose apatinib and carinizumab,in whom 41 patients in the combination group and 35 patients in the control group were given conventional TACE treatment.The combination group was treated with oral low-dose apatinib(200 mg/125 mg/alternate daily)and injectable carinizumab(200 mg/3 weeks)on the basis of TACE treatment.Recent outcomes,changes in T lymphocyte subset count levels in peripheral blood,and differences in survival were compared between the two groups.Results 1)After 3 and 6 months of treatment,ORR was 48.78%,43.90%in the combination group and 25.71%,20,00%in the control group;The DCR was 87.70%±78.05%in the combination group and 68.60%±48.57%in the control group.ORR and DCR were significantly higher in the combination group(P<0.05;2)There were nosignificant differences in peripheral blood CD3^(+),CD4^(+),CD8^(+)T lymphocyte counts and CD4^(+)/CD8^(+)between the two groups before treatment(P>0.05);The counts of all subsets of T lymphocytes and CD4^(+)/CD8^(+)in the combination group increased significantly after treatment compared with before treatment(P<0.05);The count levels of each subset of T lymphocytes and CD4^(+)/CD8^(+)in the combination group at all stages after treatment were higher than those in the control group(P<0.05);3)The combination group had significantly improved median OS and median PFS compared with the control group(P<0.05);4)The incidence of apatinib related adverse effects was low,all lower than grade 3;The incidence of adverse events associated with the addition of cabozantinib was high,but all were lower than grade
作者
郭潇
尚亚男
刘龙
徐浩
GUO Xiao;SHANG Yanan;LIU Long;XU Hao(Graduate School,Xuzhou Medical University,Xuzhou 221004,China;Department of Interventional Radiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,China)
出处
《医学影像学杂志》
2022年第8期1310-1316,共7页
Journal of Medical Imaging
基金
江苏省医学重点学科创新团队项目(编号:CXTDA2017028)。
关键词
肝细胞癌
经导管肝动脉化疗栓塞术
阿帕替尼
卡瑞利珠
淋巴细胞亚群
介入性
放射学
Hepatocellular carcinoma
Transcatheter arterial chemoembolization
Apatinib
Camrelizumab
Lymphocyte subsets
Interventional Radiology
