分子靶标检测在原发性肝癌切除术后化疗栓塞中的价值

发布时间：2018-01-18 09:45

本文关键词：分子靶标检测在原发性肝癌切除术后化疗栓塞中的价值　出处：《郑州大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的近年来应用分子靶标检测筛选高敏感性化疗药物用于恶性肿瘤的临床治疗在非小细胞肺癌、乳腺癌及结直肠癌中的研究较为多见,并且给患者带来了显著的生存获益,然而原发性肝癌利用分子靶标检测进行个体化治疗却鲜有研究。肝动脉介入化疗栓塞(Transcatheter Arterial Chemoembolization,TACE)是预防原发性肝癌术后复发的重要措施之一,但化疗药物的选择具有盲目性,无明确理论依据。本研究即探讨药物相关分子靶标检测筛选高敏感化疗药物在原发性肝癌切除术后个体化预防性肝动脉介入化疗栓塞治疗中的临床意义和价值。方法回顾性分析整理2012年5月-2013年5月在郑州大学第五附属医院肝胆胰腺外科行肝癌切除术并于术后行预防性TACE治疗的92例原发性肝癌患者的临床及随访资料,其中依据化疗药物选择方式分为分子靶标检测TACE组和经验TACE组,所有患者随访时间均为24个月,随访方式为门诊及电话随访,对两组患者术后肿瘤复发率、无瘤生存期、生存率及相关毒副反应发生情况进行比较,采用χ2检验、t检验、秩和检验、Log-rank检验等统计方法进行统计分析,以α=0.05为检验水准。结果分子靶标检测TACE组患者术后1、2年复发率分别为8%、24%,经验TACE组患者术后1、2年复发率为23.8%、45.2%,两组比较差异有统计学意义(P0.05)。分子靶标检测TACE组及经验TACE组患者平均无瘤生存期分别为(22.14±4.15)月、(19.07±5.807)月,差异有统计学意义(P0.05),两组无瘤生存曲线有显著性差异(P0.05)。分子靶标检测TACE组患者术后1、2年生存率为96%、88%,经验TACE组患者术后1、2年生存率为80.95%、71.43%,两组比较差异有统计学意义(P0.05)。毒副反应方面,分子靶标检测TACE组患者骨髓抑制、胃肠道反应程度均低于经验TACE组患者,差异有统计学意义(P0.05),而发热、肝肾功能异常、腹痛发生率两组患者无显著性差异(P0.05)。结论1、分子靶标检测筛选敏感化疗药物在原发性肝癌根治性切除术后预防性TACE中的化疗药物方案制定方面具有明确的针对性,符合个体化、精准医疗原则;2、依据分子靶标检测结果筛选敏感化疗药物用于原发性肝癌根治性切除术后预防性TACE,可适当延缓肿瘤复发、延长无瘤生存期、提高近期生存率、降低不良反应程度;3、分子靶标检测对原发性肝癌根治性切除术后预防性TACE中化疗药物的筛选具有一定的临床指导价值。
[Abstract]:Objective to screen highly sensitive chemotherapeutic drugs for malignant tumors by molecular target detection in recent years, the study on non-small cell lung cancer, breast cancer and colorectal cancer is more common. And to patients with significant survival benefits. However, there are few studies on individualized treatment of primary liver cancer using molecular target detection. Hepatic artery chemoembolization. Transcatheter Arterial Chemoembolization. TACEE is one of the important measures to prevent the recurrence of primary liver cancer, but the choice of chemotherapeutic drugs is blind. This study was to explore the clinical significance and value of screening highly sensitive chemotherapeutic drugs for individualized prophylactic hepatic arterial chemoembolization after resection of primary liver cancer. Methods from May 2012 to May 2013, 92 patients with primary liver cancer underwent hepatectomy and prophylactic TACE treatment in the Department of Hepatobiliary and Pancreatic surgery, 5th affiliated Hospital of Zhengzhou University. Clinical and follow-up data of the patients. According to chemotherapeutic drug selection, the patients were divided into molecular target detection TACE group and experienced TACE group. All the patients were followed up for 24 months. The follow-up mode was outpatient and telephone follow-up. The tumor recurrence rate, tumor-free survival time, survival rate and the incidence of related side effects were compared between the two groups. The 蠂 2 test and rank sum test were used. Log-rank test and other statistical methods were used for statistical analysis. Results the recurrence rates of TACE patients in the molecular target group were 8% and 24% respectively in 1 year and 2 years after operation. In TACE group, the recurrence rate was 23.8% and 45.2% at 1 and 2 years postoperatively. The difference between the two groups was statistically significant (P 0.05). The mean tumor-free survival time in TACE group and TACE group was 22.14 卤4.15 months. At 19.07 卤5.807 months, the difference was statistically significant (P 0.05). There was a significant difference in the survival curve between the two groups (P 0.05). The 2-year survival rate was 96% and 71.43% in the TACE group. There was significant difference between the two groups (P 0.05). In the side effects, the degree of gastrointestinal reaction in TACE group was lower than that in experienced TACE group. The difference was statistically significant (P 0.05), but there was no significant difference between the two groups in the incidence of fever, abnormal liver and kidney function and abdominal pain. Conclusion 1. Molecular target detection and screening of sensitive chemotherapeutic drugs for the formulation of chemotherapeutic drugs in preventive TACE after radical resection of primary liver cancer have clear pertinence, accord with individualized and accurate medical principles. 2. Screening sensitive chemotherapeutic drugs for prophylactic TACEE after radical resection of primary liver cancer according to the results of molecular target detection can delay tumor recurrence, prolong tumor-free survival, and improve short-term survival rate. Reducing the degree of adverse reactions; 3. The detection of molecular target has certain clinical guiding value for the screening of chemotherapeutic drugs in preventive TACE after radical resection of primary liver cancer.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.7

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