Clinical Observation Of Sorafenib In Intermediate And Advanced Hepatocellular Carcinoma

Objective:Discussion sorafenib in patients with intermediate and advanced hepatocellular carcinoma treatment efficacy and safety.Methods:A retrospective analysis from October 2009 to October 2015 period, Guangxi Medical University Cancer Hospital have a complete diagnosis and treatment, confirmed by pathology or clinical diagnosis, in line with advanced hepatocellular carcinoma (HCC), patients treated with sorafenib Depending on whether the line with TACE divided into Group A (simple oral sorafenib group), group B (oral sorafenib plus TACE group). Every 4-8 weeks the patient returned to the hospital review assessment, sorafenib follow-up table records patient survival and adverse events. Tumor effect by modified RECIST criteria for evaluating patients. Final statistical data processing.Results:All patients enrolled in line with total 79 people, including 62 males,17 females; sorafenib group and TACE group sorafenib plus two sets of data were:Gender:male (female):32 (8) vs30 (9), the average age (years):51 vs 49 years, total serum bilirubin (μmol/L):12 vs 13, ALB (g/L):38 vs 40, ALT (IU/L):40 vs 43, PT (s):14 vs 13, the number of anti-viral therapy:27 vs 29, the number of hepatitis B positive:35 vs 30, cirrhosis of the liver:26 vs 22, tumor diameter (cm):13 vs 12, vascular invasion:26 (14) vs 21 (18), Barcelona stages of B (C s):8 (32) vs 13 (26), liver function grade A (grade B):24 (16) vs 30 (9), cirrhosis of the liver:26 vs 22, the number of metastasis outside the liver: 11 vs 12, portal vein thrombosis (Ⅰ/Ⅱ/Ⅲ/Ⅳ):(15/10/6/1) vs (13/8/5/0). Before treatment between the two groups of gender, age, TBil, ALB, ALT, PT, anti-viral therapy, positive hepatitis B, liver cirrhosis, tumor size, vascular invasion, Barcelona stage, liver function, liver metastasis, portal vein thrombosis respects no statistically significant (P> 0.05). Six months after tumor efficacy comparison:the overall effect (CR+PR) response rate in group A than in group B, there was significant difference was statistically significant (P<0.05); PD rate in group A than in group B, and there was statistically significant (P<0.05); taking sorafenib major adverse events were hand-foot skin reaction, hypertension, fatigue, bone marrow suppression (neutropenia, thrombocytopenia, anemia), vomiting, hair loss, diarrhea, upper gastrointestinal hemorrhage and hepatic encephalopathy, in addition to hepatic encephalopathy after all complications were symptomatic treatment can significantly alleviate. Sorafenib HCC patients with Child-pugh A, class B, the median survival time was 18.8 months and 12.3 months (P<0.01), BCLC-B, BCLC-C Interim median survival time was 20.5 months,15.7 months (P= 0.02). BCLC-B, C in patients with 1, 2-year survival rates were 86%,24% and 62%,17%. PVTT it, II, III, IV patients with overall survival was:19.4 months,14.1 months,8.2 months,3.0 months. PVTT Ⅰ, Ⅱ and overall survival time PVTT III, IV (P<0.01). Overall survival PVTT I and Type II (P= 0.001). But PVTT III and PVTT IV (P= 0.20). Extrahepatic metastases, accounting for 23, accounting for 14 lung metastasis,4 adrenal metastasis, bone metastasis 3, spleen, gallbladder transfer each one, there are five simple lung metastasis.Conclusions:1, TACE combined with sorafenib in the treatment of advanced hepatocellular carcinoma than mere oral sorafenib treatment can improve tumor response rate, overall survival time prolonged, and in combination with TACE does not increase the incidence of adverse reactions sorafenib; Sola TACE combined with sorafenib patients can get better steady state disease and longer survival time, as may be further supplemented with advanced hepatocellular carcinoma treatment modality.2, Barcelona installments sorafenib treatment of advanced liver cancer in effect:Barcelona B Barcelona C patients compared with patients to better improve the overall survival time of patients with liver cancer, one of Barcelona staging prognostic factors affect sorafenib.3, Child classification sorafenib treatment of advanced liver cancer in effect:Child-pugh A good grade of hepatic malignancies, Child-pugh B liver cancer patients can tolerate sorafenib. Child-pugh classification of liver function as affecting the efficacy of sorafenib prognostic factors.4, HBV-related hepatocellular carcinoma, anti-viral treatment for advanced liver cancer long-term efficacy no significant benefit.5, PVTT type for PVTT hepatocellular carcinoma sorafenib efficacy of anticipation, PVTT I/ Type II hepatocellular carcinoma sorafenib good effect, PVTT III/IV hepatocellular carcinoma sorafenib poor.6, extrahepatic metastasis of liver cancer using sorafenib, simple pulmonary metastasis greater benefit.