S-TACE联合阿帕替尼对原发性肝癌疗效及其机制的研究

发布时间：2018-06-18 21:23

本文选题：原发性肝癌 + 超选择性肝肿瘤动脉化疗栓塞术　；参考：《延边大学》2017年硕士论文

【摘要】：目的探讨S-TACE联合阿帕替尼治疗原发性肝癌患者血清和肝癌组织中血管生成因子的表达及其临床意义。方法收集我院2015年1月至2015年6月收治的原发性肝癌患者46例,分为单纯S-TACE组(A组,n=23)和S-TACE联合阿帕替尼组(B组,n=23)。检测所有患者治疗前、后血清VEGF、HIF-1α浓度及肝功能。部分患者(20例)经B超引导下穿刺活检获取肝肿瘤标本,采用免疫组化染色法检测术前及术后第4周肿瘤组织中VEGFR-2表达及MVD。根据46例患者术前及术后第4周肝脏CT增强扫描的肝内病灶变化,比较两组DCR及OR。观察与S-TACE及口服阿帕替尼相关不良反应的发生情况,随访3个月-2年,分析疾病进展情况。结果1.A、B两组术后第1周肝功能AST、ALT、TBIL及DBIL均较术前升高,具有统计学差异(P0.05),治疗后A、B组间比较不具有统计学差异。2.A组术后第1周、第4周血清VEGF、HIF-1α浓度与术前比较表现为先上升后下降;B组术后第1周、第4周血清VEGF、HIF-1α与术前比较呈持续下降,具有统计学差异(P0.05)。治疗后第4周组间比较;B组下降更明显,具有统计学差异(P0.05)。3.A、B两组术后第4周肝癌组织中VEGFR-2阳性表达率及MVD均低于术前,且B组下降更明显,具有统计学差异(P0.05)。4.A、B两组术后肿瘤直径均较术前缩小,治疗后A、B组间比较B组肿瘤缩小更显著,具有统计学差异(P0.05)。5.B组术后 4 周DCR为 95.65%、OR为 60.87%,A组DCR为 82.61%、OR为34.78%,B组虽然高于A组,但不具有统计学差异(P0.05)。6.B组的TTP为 11.72±4.94 月,A组TTP为 8.15±4.74 月,B组TTP长于A组,具有统计学差异(P0.05)。结论1.S-TACE联合阿帕替尼治疗肝癌疗效优于单纯S-TACE,其机制与抑制肿瘤的血管生成有关。2.S-TACE联合阿帕替尼可延长患者TTP,改善预后,提高生存。
[Abstract]:Objective to investigate the expression and clinical significance of angiogenic factor in serum and liver cancer tissues of patients with primary liver cancer treated with S-TACE combined with apatinib. Methods from January 2015 to June 2015, 46 patients with primary liver cancer were divided into two groups: S-TACE group (group A) and S-TACE group (group B) combined with Apatinib group (group B). The serum level of VEGF HIF-1 伪 and liver function were measured before and after treatment. Liver tumor specimens were obtained by B-ultrasound guided biopsy. The expression of VEGFR-2 and MVD were detected by immunohistochemical staining before and 4 weeks after operation. According to the changes of hepatic lesions in 46 patients before and 4 weeks after operation, DCR and ORs were compared between the two groups. The adverse reactions associated with S-TACE and oral apatinib were observed and followed up for 3 months to 2 years to analyze the progress of the disease. Results 1. The liver function of group A B was significantly higher than that of group A (P 0.05) at the 1st week after operation. There was no significant difference between group A and group A in the first week after operation. 2. There was no significant difference between group A and group A at the first week after operation, and there was no significant difference between group A and group A in the first week after operation (P < 0.05). At the 4th week, the serum level of VEGFU HIF-1 伪 increased at first and then decreased at the first week after operation. At the 4th week, the serum level of VEGFU HIF-1 伪 decreased continuously compared with that before operation, and there was a statistical difference between the two groups (P 0.05). The expression of VEGFR-2 and MVD in liver cancer tissues in group B were significantly lower than those in group B at the 4th week after treatment, and the decrease was more significant in group B than that in group B at the 4th week after treatment, and there was statistical difference between group B and group B (P 0.05. 3.) the positive expression rate of VEGFR-2 and MVD were significantly lower in group B than before operation. After treatment, the diameter of tumor in group A was significantly smaller than that in group B, and the DCR of group A was 95.65% (OR = 60.87) 4 weeks after treatment, although the DCR of group B was higher than that of group A (34.78%, P < 0.05), and that of group A was significantly lower than that of group B (P < 0.05), and that of group A was significantly higher than that of group B (P < 0.05), and that of group A was significantly higher than that of group B (P < 0.05), and that of group A was significantly higher than that of group B (P < 0.05). However, the TTP of group A was 8.15 卤4.74 months longer than that of group A, and the TTP of group B was longer than that of group A (11.72 卤4.94 months, P < 0.05). Conclusion 1. The therapeutic effect of S-TACE combined with apatinib on liver cancer is better than that of S-TACE.The mechanism of S-TACE combined with Apatinib is related to the inhibition of tumor angiogenesis. 2. S-TACE combined with apatitinine can prolong TTP, improve prognosis and improve survival. 2.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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