摘要目的 观察靶向药物索拉非尼对晚期肝细胞癌患者的临床疗效及患者的生存情况.方法 将2013年1月至2015年1月长安医院收治的66例肝细胞癌患者纳入本研究,按照随机数字表法将患者随机分为肝动脉化疗栓塞(TACE)组(n=33)和索拉非尼+TACE组(n=33).随访2年,观察临床疗效,包括患者疾病控制率、6个月及1年生存率,比较治疗前后血清甲胎蛋白水平变化及在治疗期间出现的相关不良反应.结果 索拉非尼+ TACE组的疾病控制率为84.85％ (28/33),显著高于TACE组的60.61％ (20/33),差异有统计学意义(x2=4.889,P=0.027).索拉非尼+TACE组患者的中位生存期为20.30个月,相较于TACE组(12.50个月)明显延长,差异有统计学意义(x2=29.570,P=0.000).索拉非尼+TACE组患者6个月、1年生存率分别为93.93％、75.76％,均高于TACE组(84.85％、51.52％).索拉非尼+TACE组的1年复发转移率为21.21％,与TACE组(39.39％)相比明显降低,差异有统计学意义(x2=2.908,P=0.041).治疗6个月后,索拉非尼+TACE组患者血清甲胎蛋白水平为(1 911.53±457.86)ng/ml,显著低于TACE组(2 979.83±842.71) ng/ml,差异有统计学意义(t=11.996,P=0.001).Child-Pugh评分为A的患者其中位生存期明显长于Child-PughB的患者(20.50个月∶13.95个月),差异有统计学意义(x2=3.973,P=0.046).索拉非尼+TACE组和TACE组患者均出现恶心、呕吐、肝功能异常等不良反应,两组患者不良反应发生率比较,差异有统计学意义(87.88％∶60.61％;x2=6.418,P=0.011).结论 在TACE基础上应用索拉非尼治疗晚期肝细胞癌能够有效提高疾病控制率,延长患者生存期,提高患者生存率.

abstractsObjective To observe the clinical curative effet and survival condition of sorafenib for patients with advanced hepatocellular carcinoma.Methods Sixty-six patients with hepatocellular carcinoma during January 2013 to January 2015 in Chang'an Hospital were included.All patients were randomly divided into transcatheter arterial chemoembolization (TACE) group (n =33) and sorafenib + TACE group (n =33) according to the random digital table method.Followed up for 2 years,we observed the clinical curative effect,including 6-months survival rate,1-year survival rate,the changes of serum alpha fetoprotein level before and after the treatment,survival time and related adverse reactions.Results The disease control rate of sora-fenib + TACE group was 84.85％ (28/33),which was significantly higher than that of TACE group (60.61％,20/33),and the difference was statistically significant (x2 =4.889,P =0.027).The median survival time of patients with sorafenib +TACE group was 20.30 months,which was longer than that of TACE group (12.50 months),and the difference was statistically significant (x2 =29.570,P =0.000).The 6-months and 1-year survival rates in patients with sorafenib + TACE group were 93.93％ and 75.76％,respectively,which were significantly higher than those of TACE group (84.85％,51.52％).The rate of 1-year recurrence and metastasis of sorafenib + TACE group was 21.21％,which was lower than that of TACE group (39.39％),and the difference was statistically significant (x2 =2.908,P =0.041).After 6 months treatment,the serum level of alpha fetoprotein in patients with sorafenib + TACE group was (1 911.53 ± 457.86)ng/ml,which was signi-ficantly lower than that of TACE group [(2 979.83± 842.71)ng/ml],and the difference was statistically significant (t =11.996,P =0.001).The median survival time of patients with Child-Pugh A was significantly longer than that of patients with Child-Pugh B (20.50 months vs.13.95 months),with a significant difference (x2 =3.973,P =0.046).Patients in sorafenib + TACE group and TACE group had adverse reactions including nausea,vomiting and abnormal liver function,and there was significant difference in the incidence of untoward effects (87.88％ vs.60.61％;x2 =6.418,P =0.011).Conclusion The application of sorafenib the-rapy in the treatment of advanced hepatocellular carcinoma based on TACE can effectively improve the disease control rate,prolong the survival time of patients and improve the survival rate of patients.