Study on the efficacy and safety of FOLFOX4 regimen hepatic arterial infusion chemotherapy combined with 125I seed implantation in patients with primary liver cancer and type Ⅲ portal vein tumor thrombus / 中国医师进修杂志

ABSTRACT

Objective:To explore the efficacy and safety of FOLFOX4 regimen hepatic arterial infusion chemotherapy (HAIC) combined with 125I seed implantation or gamma knife in patients with primary liver cancer and type Ⅲ portal vein tumor thrombosis (PVTT). Methods:The clinical data of 116 patients with primary liver cancer and type Ⅲ PVTT from January 2016 to June 2018 in the Sixth Medical Center of PLA General Hospital were retrospectively analyzed. Among them, 56 patients were treated with FOLFOX4 regimen HAIC combined with 125I seed implantation in PVTT (observation group), and 56 patients were treated with FOLFOX4 regimen HAIC combined with gamma knife in PVTT (control group). The clinical efficacy, adverse reactions, liver function, tumor serum markers, quality of life and portal venous pressure were compared between 2 groups. The patients were followed up to June 2021, the progression-free survival (PFS) time, overall survival (OS) time and 1-, 3-year survival rate were recorded. Results:The objective response rate and disease control rate in observation group were significantly higher than those in control group: 21.43% (12/56) vs. 7.14% (4/56) and 50.00% (28/56) vs. 30.36% (17/56), and there were statistical differences ( P<0.05). The aspartate transaminase (AST), alanine transaminase (ALT), total bilirubin, alpha fetoprotein (AFP), carcinoembryonic antigen (CEA) and tumor supplied group of factor (TSG) after treatment in observation group were significantly lower than those in control group: (58.24 ± 7.16) U/L vs. (67.81 ± 8.39) U/L, (56.39 ± 5.42) U/L vs. (62.87 ± 6.83) U/L, (21.21 ± 4.32) μmol/L vs. (25.88 ± 4.71) μmol/L, (32.98 ± 6.15) μg/L vs. (45.06 ± 7.24) μg/L, (2.39 ± 0.22) μg/L vs. (3.17 ± 0.26) μg/L and (57.81 ± 5.67) kU/L vs. (66.19 ± 5.45) kU/L, and there were statistical differences ( P<0.01). The quality of life questionnaire core-30 (QLQ-C30) score after treatment in observation group was significantly higher than that in control group: (68.13 ± 6.95) scores vs. (64.49 ± 6.73) scores, the portal venous pressure after treatment in observation group was significantly lower than that in control group: (31.85 ± 3.89) cmH 2O (1 cmH 2O = 0.098 kPa) vs. (35.37 ± 4.23) cmH 2O, and there were statistical differences ( P<0.01). There was no statistical difference in incidence of adverse reactions between 2 groups ( P>0.05). Two cases were lost in observation group and 3 cases in the control group; the PFS time and OS time in observation group were significantly longer than those in control group: (13.36 ± 2.85) months vs. (11.76 ± 2.60) months and (23.36 ± 4.37) months vs. (20.72 ± 3.96) months, and there were statistical differences ( P<0.01); the 1-year survival rate in observation group was significantly higher than that in control group: 70.37% (38/54) vs. 50.94% (27/53), and there was statistical difference ( P<0.05); there was no statistical difference in 3-year survival rate between 2 groups ( P>0.05). Conclusions:The anti-tumor effect and the improvement effect on liver function in patients with primary liver cancer and type Ⅲ PVTT treated with FOLFOX4 regimen HAIC combined with 125I seed implantation are better than combined gamma knife, and it has high safety and longer survival time.