HIFU联合基因检测指导下化疗治疗晚期胰腺癌的初步临床观察

发布时间：2017-12-28 00:14

  本文关键词：HIFU联合基因检测指导下化疗治疗晚期胰腺癌的初步临床观察　出处：《重庆医科大学》2016年硕士论文　论文类型：学位论文

  更多相关文章： 胰腺癌 高强度聚焦超声 基因检测 化疗

【摘要】：目的:通过临床观察分析高强度聚焦超声(HIFU)联合基因检测指导化疗治疗晚期胰腺癌疗效及其副反应,探讨HIFU联合基因检测指导化疗在晚期胰腺癌治疗中的应用价值。方法:21例符合纳入标准的确诊的晚期胰腺癌(III期3例,IV期18例)HIFU治疗后均接受了化疗。其中,8例化疗是在基因检测指导下选择化疗方案,13例则选择传统的胰腺癌一线化疗方案,即分为基因检测组(8例)和非基因检测组(13例)。仔细观察、记录HIFU治疗前后患者的副作用、血生化、疼痛变化,及化疗的毒副反应,并采用SPSS 19.0软件进行统计分析,评价HIFU的疗效及两组患者间的差异。HIFU治疗后2周采用增强MRI或CT对肿瘤消融情况进行评估,并计算肿瘤消融百分比。随访所有患者的生存情况,采用Kaplan-Meier法进行生存分析,并比较基因检测组与非基因检测组间的生存差异。结果:21例患者HIFU治疗前肿瘤相关性疼痛(VAS视觉模拟量表,VAS)15例,HIFU治疗后完全缓解3例(20.00%),部分缓解10例(66.67%),稳定1例(6.67%),加重1例(6.67%),治疗有效率为86.67%(完全缓解+部分缓解)。HIFU前后比较,治疗后疼痛(VAS评分,4.62±3.67 vs 1.95±1.86)明显缓解,且具有统计学意义(t检验,P=0.000);胆红素、血糖无统计学意义(P0.05)。HIFU治疗后肿瘤消融率平均为(90.58±6.91)%,且与患者生存显著正相关(Peorson相关分析,P=0.013),基因检测组与非基因检测组肿瘤消融率差异无统计学意义(P=0.55)。21例患者平均随访8.19±6.10月,6月、12月生存率依次分别为42.9%、26.7%~33.3%,中位生存时间为6.00(95%CI=4.22~7.78)月,平均生存时间为9.92±1.91(95%CI=6.18~13.65)月。基因检测组与非基因检测组的6月、12月生存率依次分别为62.5%~75%vs 23.1%、41.7~62.5%vs 7.7%~15.4%,中位生存时间及平均生存时间依次分别为17.00(95%CI=1.58~32.42)月与5.00(95%CI=3.85~6.15)月、16.08±3.58(95%CI=9.07~23.10)月与5.70±1.01(95%CI=3.71~7.68)月,两组比较,基因检测组生存高于非基因检测组,且具有统计学意义(Log Rank,P=0.015)。基因检测组患者化疗后按WHO分级标准无Ⅲ级和/或Ⅳ级毒副反应发生,非基因检测组中发现Ⅲ级毒副反应7例(53.85%),两组比较,其差异具有统计学意义(秩和检验,P=0.02)。结论:1.HIFU治疗能显著缓解晚期胰腺癌疼痛,是晚期胰腺癌姑息性治疗的安全有效方法之一;2.HIFU联合基因检测指导下的化疗治疗晚期胰腺癌能延长患者生存期、降低化疗后副反应,可能是晚期胰腺癌可供选择的治疗方案之一。
[Abstract]:Objective: To observe the efficacy and side effects of high intensity focused ultrasound (HIFU) combined with gene detection in guiding the treatment of advanced pancreatic cancer through clinical observation and analysis, and to explore the value of HIFU combined with gene detection in guiding the chemotherapy in the treatment of advanced pancreatic cancer. Methods: 21 patients with advanced pancreatic cancer (3 cases in III phase and 18 cases in IV phase) were treated with chemotherapy after HIFU treatment. Among them, 8 cases received chemotherapy under the guidance of gene detection, and 13 cases chose the traditional first-line chemotherapy plan for pancreatic cancer. They were divided into gene detection group (8 cases) and non gene detection group (13 cases). The side effects, blood biochemical and pain changes, and side effects of chemotherapy were carefully observed and recorded before and after HIFU treatment. Statistical analysis was performed by SPSS 19 software to evaluate the efficacy of HIFU and the difference between the two groups. 2 weeks after HIFU treatment, the tumor ablation was evaluated by enhanced MRI or CT, and the percentage of tumor ablation was calculated. The survival of all the patients was followed up by Kaplan-Meier, and the survival difference between the gene test group and the non gene test group was compared. Results: in 21 patients, there were 15 cases of tumor related pain (VAS visual analog scale, VAS) before HIFU treatment, 3 cases (20%) were completely relieved after HIFU treatment, 10 cases (66.67%) were partial remission, 1 cases (6.67%) were stable, 1 cases (6.67%) were aggravated, and the effective rate of treatment was 86.67% (complete relief + partial remission). After HIFU, pain after treatment (VAS score, 4.62 + 3.67 vs 1.95 + 1.86) was significantly relieved, with statistical significance (t test, P=0.000). Bilirubin and blood glucose were not statistically significant (P0.05). The average ablation rate of tumor after HIFU treatment was (90.58 + 6.91)%, which was significantly positively correlated with the survival of patients (Peorson correlation analysis, P=0.013). There was no significant difference in tumor ablation rate between gene detection group and non gene detection group (P=0.55). 21 patients were followed up for an average of 8.19 + 6.10 months. The survival rates in June and December were 42.9% and 26.7%~33.3%, respectively. The median survival time was 6 (95%CI=4.22~7.78) months, with an average survival time of 9.92 + 1.91 (95%CI=6.18~13.65) months. Detection of gene group and gene detection group in June, December respectively. The survival rate of 62.5%~75%vs 23.1%, 41.7~62.5%vs 7.7%~15.4%, the median survival time and median survival time were 17 months (95%CI=1.58~32.42) and 5 (95%CI=3.85~6.15) months, 16.08 + 3.58 (95%CI=9.07~23.10) and 5.70 + 1.01 (95%CI=3.71~7.68) months, two group, genetic testing group survival was higher than that of non genetic testing group, and have statistical significance (Log, Rank, P=0.015). There was no grade III or / or IV toxicity in the gene detection group according to the WHO grading standard after chemotherapy. In the non gene detection group, there were 7 cases of grade III toxicity (53.85%). The difference between the two groups was statistically significant (rank sum test, P=0.02). Conclusion: 1.HIFU treatment can significantly relieve pain of advanced pancreatic cancer, is one of the safe and effective method for palliative treatment of advanced pancreatic cancer; chemotherapy in the treatment of advanced pancreatic cancer combined with detection of 2.HIFU gene under the guidance of can prolong survival and reduce the side effects of chemotherapy, may be one of the treatment options for advanced pancreatic cancer.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.9

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