卡瑞利珠单抗联合索拉非尼治疗中晚期肝细胞癌患者甲胎蛋白应答变化及对预后的评价

摘要/Abstract

摘要： 目的分析卡瑞利珠单抗联合索拉非尼治疗中晚期肝细胞癌患者甲胎蛋白应答变化及对预后的评价。方法 2019年4月至2021年4月四川省三台县人民医院收治的经卡瑞利珠单抗联合索拉非尼治疗的中晚期肝细胞癌患者60例,治疗8个月后根据患者的治疗是否应答分为应答组35例和非应答组25例。比较两组临床病理特征及转归情况。采用Kaplan-Meier生存评估两组生存率。采用多因素Cox回归分析影响中晚期肝细胞癌患者预后的危险因素。结果应答组的血红蛋白水平为(138.2±23.6)g/L,高于非应答组的(122.5±21.2)g/L(P<0.05);治疗后应答组甲胎蛋白、总胆红素水平分别为(172.3±21.5)ng/mL、(12.3±2.1)μmol/L,低于非应答组的(468.9±71.2)ng/mL、(21.2±4.1)μmol/L(P<0.05)。应答组的甲胎蛋白早期应答率、疾病缓解率、疾病控制率分别为91.4%(32/35)、82.9%(29/35)、37.1%(13/35),非应答组分别为28.0%(7/25)、60.0%(15/25)、12.0%(3/25)(P<0.05)。截止到2021年3月,应答组无进展生存期为9个月,非应答组的无进展生存期为6个月,应答组的总生存期为13个月,非应答组的总生存期为11个月,死亡20例,其中应答组8例,非应答组12例;应答组的生存情况优于非应答组。多因素Cox回归分析结果显示,甲胎蛋白早期应答是影响中晚期肝细胞癌患者预后的独立危险因素(OR=3.511,P<0.05)。结论卡瑞利珠单抗联合索拉非尼治疗中晚期肝癌疗效显著,甲胎蛋白的早期反应对评价患者预后具有较好的应用价值。

关键词: 卡瑞利珠单抗, 索拉非尼, 中晚期肝细胞癌, 甲胎蛋白, 应答变化, 预后

Abstract: Objective To analysis the alpha-fetoprotein (AFP) response and its prognostic evaluation value of patients with advanced hepatocellular carcinoma (HCC) treated with karelizumab in combination with sorafenib. Methods Sixty patients with intermediate and advanced HCC treated with karelizumab combined with sorafenib who were admitted between April 2019 and April 2021 were categorized into 35 cases in the responding group and 25 cases in the non-responding group according to whether the patients responded to the treatment after 8 months of treatment. The clinicopathologic characteristics and tumor regression of the two groups were compared. Kaplan-Meier survival analysis was used to assess the survival in both groups. To analyze the risk factors affecting the prognosis of patients with middle and advanced HCC using multifactorial Cox regression. Results The hemoglobin level in the responder group was (138.2±23.6) g/L, which was higher than that in the non-responder group [(122.5±21.2) g/L, P<0.05]; the levels of AFP and total bilirubin after treatment in the responder group were (172.3±21.5) ng/mL and (12.3±2.1) μmol/L, respectively, which were lower than that of (468.9± 71.2) ng/mL, (21.2±4.1) μmol/L in the non-responder group [P<0.05]; the rates of early response to AFP, disease remission, and disease control in the responder group were 91.4%, 82.9%, and 37.1%, respectively, which were superior to those of 28.0%, 60.0%, and 12.0% in the mortality group [P<0.05], respectively; As of March 2021, the progression-free survival was 9 months in the responder group and 6 months in the nonresponder group, and overall survival was 13 months in the responder group and 11 months in the nonresponder group, with a total of 20 deaths, 8 in the responder group and 12 in the nonresponder group; The survival rate in the responder group was superior to that in the nonresponder group. The results of multifactorial Cox regression analysis showed that an early response of AFP was an independent risk factor affecting the prognosis of patients with intermediate and advanced HCC (OR=3.511, P<0.05). Conclusion The efficacy of karelizumab combined with sorafenib in the treatment of intermediate and advanced HCC is remarkable, and the early response of AFP has a good application value in evaluating the prognosis of patients.

Key words: Karelizumab, Sorafenib, Intermediate to advanced hepatocellular carcinoma, Alpha-fetoprotein, Response changes, Prognosis

张云江, 梁亮, 张东成. 卡瑞利珠单抗联合索拉非尼治疗中晚期肝细胞癌患者甲胎蛋白应答变化及对预后的评价[J]. 肝脏, 2024, 29(7): 784-787.

ZHANG Yun-jiang, LIANG Liang, ZHANG Dong-cheng. The alpha-fetoprotein response and its prognostic evaluation value for patients with advanced hepatocellular carcinoma treated with karelizumab in combination with sorafenib[J]. Chinese Hepatolgy, 2024, 29(7): 784-787.

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