摘要
背景与目的:应用经肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗肝癌存在着坏死率低的不足,^(125)I粒子植入术作为一项新的放疗技术具有靶向性强的优点。本研究旨在观察含洛铂方案TACE联合^(125)I粒子植入术对不能手术的中晚期肝癌患者的临床疗效及3年生存情况,为肝癌的临床治疗提供参考。方法:前瞻性研究设计,选取2010年1月—2013年1月郑州大学附属肿瘤医院收治的中晚期肝癌患者102例,随机数字表法分为观察组和对照组,每组51例。对照组患者接受含洛铂方案TACE治疗,观察组患者在对照组治疗方案的基础上加用^(125)I粒子植入术。观察两组患者治疗前和治疗后6个月的甲胎蛋白(alphafetoprotein,AFP)、肝功能指标、细胞免疫指标变化情况及肿瘤转移情况,比较两组患者治疗后的近期疗效及3年生存率,并记录随访期内不良反应发生情况。结果:治疗前两组患者一般资料及临床相关指标比较差异均无统计学意义(P均>0.05)。经不同方案治疗后,观察组近期有效率(86.3%)显著高于对照组(68.6%);治疗后6个月,两组患者血清AFP检测水平较治疗前明显降低,其中观察组患者血清AFP水平下降幅度显著大于对照组(P<0.05);两组患者肝功能指标及细胞免疫指标比较差异无统计学意义(P>0.05);观察组治疗后6个月远处转移的发生率(7.8%)明显低于对照组(23.5%),术后1、2和3年内生存率分别为68.6%、43.1%和31.4%,均明显高于对照组(41.2%、29.4%和13.7%),差异均有统计学意义(P均<0.05);两组患者随访期间均未出现严重并发症。结论:含洛铂方案TACE联合^(125)I粒子植入术治疗不能手术的中晚期肝癌的疗效确切,与单纯含洛铂方案TACE治疗相比优势明显,能更有效的控制肿瘤转移,提高生存率,值得在临床推广应用。
Background and purpose： Transcatheter arterial chemoembolization （TACE） in the treatment of hepatocellular carcinoma is characterized by a low rate of necrosis, while 125I seed implantation, as a new radiotherapy technique, has strong targeting advantages. In this study, we aimed to explore the clinical efficacy of 125I seed implantation combined with TACE therapy （combined with lobaplatin as a chemotherapy drug） and 3-year survival of patients with advanced unresectable primary hepatocellular carcinoma, and to provide reference for the clinical treatment. Methods： In the prospective study, 102 patients with advanced unresectable primary hepatocellular carcinoma at the Affiliated Tumor Hospital of Zhengzhou University from January 2010 to January 2013 were selected and randomly divided into control group and observation group with 51 cases in each group. Patients in control group were treated with TACE, and the patients in observation group were treated with TACE combined with 125I particles implantation. The changes of alpha-fetoprotein （AFP）, liver function, cell immune indexes and tumor metastasis and curative effect were observed before and after 6 months of treatment. The clinical effect, 3-year survival rate and adverse reactions of the two groups were recorded and compared. Results： There was no statistically significant difference between the two groups of patients in general information and clinical related indicators before the treatment （P〉0.05）. After different treatment procedures, the effective rate of observation group （86.3%） was significantly higher than that of the control group （68.6%）; Six months after the treatment, the serum level of AFP was significantly lower in both groups, and the serum AFP content of the observation group was significantly lower than that of the control group （P〈0.05）. There was no statistically significant difference in liver function indexes and cellular immune function indexes before the treatment and after the treatment for 6 months （P〉0.05）. The incidence of distant metastasis in the observation group was 7.8%, significantly lower than that of the control group （23.5%）, survival rates of 1, 2 and 3 year were 68.6%, 43.1% and 31.4%, which were significantly higher than those of the control group （41.2%, 29.4% and 13.7%, P〈0.05）. Both groups had no serious complications during the follow-up period. Conclusion： The 125I seed implantation combined with TACE therapy （combined with lobaplatin as a chemotherapy drug） is more effective in controlling tumor metastasis and improving the survival rate, which is worthy of clinical application.
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2017年第11期896-902,共7页
China Oncology
关键词
洛铂
经肝动脉化疗栓塞术
^(125)I粒子植入术
中晚期肝癌
前瞻性研究
Lobaplatin
Transcatheter arterial chemoembolization
t25I seed implantation
Advancedunresectable primary hepatocellular carcinoma
Prospective study
