信迪利单抗、贝伐珠单抗联合肝动脉化疗栓塞术在中晚期肝癌患者中的临床应用

Clinical efficacy of sintilimab and bevacizumab combined with TACE in treating patients with advanced liver cancer

摘要:

目的 探究信迪利单抗、贝伐珠单抗联合肝动脉化疗栓塞术（TACE）治疗中晚期肝癌患者的临床疗效。方法 选取2018年12月—2019年12月庆阳市中医医院收治的中晚期肝癌患者84例，采用随机数字表法分为研究组和对照组，每组42例。所有受试者接受TACE治疗，对照组采用贝伐珠单抗治疗，研究组在对照组基础上联合信迪利单抗治疗。治疗3个月后，评估两组临床疗效、肿瘤标志物［甲胎蛋白（AFP）、癌胚抗原（CEA）、糖类抗原199（CA199）］、免疫指标 ［CD3^＋、CD4^＋/CD8^＋、自然杀伤细胞（NK）］及药物不良反应。随访3年，记录患者无进展生存期（PFS）和总生存期（OS）。结果 研究组客观缓解率为83.33%，高于对照组的61.90%（P <0.05）。研究组、对照组疾病控制率分别为92.86%和85.71%，差异无统计学意义（P >0.05）。研究组治疗前后AFP、CEA、CA199、CD3^＋、CD4^＋/CD8^＋、NK的差值均高于对照组（P <0.05）。两组不良反应发生率比较，差异均无统计学意义（P >0.05）。随访3年，研究组死亡23例，中位PFS 14个月，中位OS 23个月，3年总生存率为42.50%；对照组死亡26例，中位PFS 10个月，中位OS 20个月，3年总生存率为31.58%。研究组PFS、OS优于对照组（P <0.05）。结论 信迪利单抗、贝伐珠单抗联合TACE治疗中晚期肝癌，可有效调节患者的肿瘤标志物和免疫因子水平，延长患者的生存时间，且安全性良好。

Abstract:

Objective To investigate the clinical efficacy of sintilimab and bevacizumab combined with transcatheter arterial chemoembolization (TACE) in the treatment of advanced liver cancer.Methods From December 2018 to December 2019, a total of 84 patients with advanced liver cancer admitted to Qingyang Hospital of Traditional Chinese Medicine were selected and divided into the study group and the control group by the random number table method, with 42 patients in each group. All patients received TACE treatment. The control group was treated with bevacizumab, while the study group was treated with sintilimab plus bevacizumab. After 3 months of treatment, the clinical efficacy, levels of tumor markers [alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA199)] and immune indexes [CD3⁺ cell, CD4⁺/CD8⁺ ratio, natural killer (NK) cell], and adverse drug reactions were compared. The patients were followed up for 3 years, and the progression free survival (PFS) and the overall survival (OS) were recorded.Results The objective remission rate of the study group was 83.33%, which was higher than that of the control group (61.90%) (P < 0.05). The disease control rates of the study group and the control group were 92.86% and 85.71%, respectively. There was no significant difference in the disease control rate between the two groups (P > 0.05). The differences of levels of AFP, CEA, CA199, CD3⁺ cell, CD4⁺/CD8⁺ ratio, and NK cell before and after the treatment in the study group were higher than those in the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). During the 3-year follow-up, 23 patients died in the study group, with a median PFS of 14 months, a median OS of 23 months and a 3-year overall survival rate of 42.50%. There were 26 cases of death in the control group, with a median PFS of 10 months, a median OS of 20 months and a 3-year overall survival rate of 31.58%. The PFS and OS in the study group were better than those in the control group (P < 0.05).Conclusions Sintilimab and bevacizumab combined with TACE effectively regulates the levels of tumor markers and immune factors in patients with advanced liver cancer, and prolongs the survival of patients with good safety.