Embosphere微球在肝癌TACE治疗中的临床疗效分析

发布时间：2019-01-04 11:27

【摘要】：目的比较Embospher微球联合碘化油化疗乳剂与常规碘化油乳剂在肝癌TACE治疗中的临床疗效。方法收集2015年10月至2016年10月,因原发性肝癌(PCL)行经导管动脉化疗栓塞术(TACE)的患者的临床资料,每例患者从首次行TACE开始,平均随访6个月。根据TACE术中是否使用Embospher微球,分为微球组(EM-TACE)和常规组(c-TACE)。根据入组标准,使两组病例在年龄、性别、HBs Ag、巴塞罗那临床分期(BCLC)、肿瘤大小、数目、血供及边界情况等方面均衡一致。比较两组患者多次TACE治疗后不良反应情况、肝功能和甲胎蛋白(AFP)的变化,并根据m RECIST标准评价首次及末次TACE术后4-6周肝癌的局部控制情况。结果符合入组标准的患者共85例,EM-TACE组40例,c-TACE组45例,随访期间所有患者接受2-4次TACE治疗,首次TACE治疗时,79例的患者实现超选择性肝动脉化疗栓塞,技术成功率为93%(79/85);多次治疗过程中,术后无一例发生肝功能衰竭、肝脓肿、急性胆囊炎等严重并发症。随访期间,EM-TACE组累计接受132次TACE治疗,人均3.3次,术后累计发热62例次,腹痛48例次,恶心或呕吐37例次;c-TACE组,分别为151次,3.4次,71例次、52例次、43例次,两组比较无统计学差异。首次TACE术后1-7天复查肝功能,丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、白蛋白(ALB)、血清总胆红素(TBIL)、结合胆红素(CB)有不同程度升高或降低,但两组比较无统计学差异;末次TACE术后4-6周肝功能各主要指标与术前一周比较无统计学差异。首次TACE术前与末次TACE术后4-6周,两组AFP均明显下降,且EM-TACE组下降程度较明显。首次TACE术后4-6周,复查上腹部增强CT或MRI,根据m RECIST标准评价肿瘤控制情况,EM-TACE组,CR、PR、SD、PD的患者计数分别为2例、20例、16例、2例,有效率(CR+PR)55.0%,获益率(CR+PR+SD)95.0%;c-TACE组,分别为0例、15例、26例、4例,有效率为33.33%,获益率91.11%,两组比较有统计学差异(P0.05)。末次TACE术后1个月,EM-TACE组,CR、PR、SD、PD分别为1例、18例、17例、4例,有效率47.5%,获益率90%;c-TACE组,分别为0例、12例、25例、8例,26.67%,82.22%,两组比较有统计学差异(P0.05)。结论 Embospher微球联合碘油化疗乳剂治疗中期肝癌,患者耐受性可,安全可行,与常规治疗无明显差异;肿瘤局部控制率优于常规碘化油化疗栓塞。TACE操作时,采用微导管超选择性技术,靶向性栓塞效果更好,而且也能减轻正常肝组织损伤。肝癌预后与BCLC分期、肿瘤大小、数目、Child分级等因素有关,此外患者的规律复查及随访也是影响预后的重要因素。
[Abstract]:Objective to compare the clinical efficacy of Embospher microspheres combined with iodized oil emulsion and routine iodized oil emulsion in the treatment of liver cancer with TACE. Methods from October 2015 to October 2016, the clinical data of patients with (TACE) undergoing transcatheter arterial chemoembolization (TACE) for primary liver cancer (PCL) were collected. Each patient was followed up for an average of 6 months from the first TACE. According to whether Embospher microspheres were used in TACE, they were divided into two groups: EM-TACE and c-TACE. According to the admission criteria, the size, number, blood supply and boundary conditions of (BCLC), tumors in, HBs Ag, Barcelona clinical stage were balanced and consistent between the two groups. The adverse reactions, liver function and alpha-fetoprotein (AFP) were compared between the two groups after repeated TACE treatment, and the local control of liver cancer was evaluated according to m RECIST criteria at 4-6 weeks after the first and last TACE. Results there were 85 patients who met the standard of admission, 40 patients in EM-TACE group and 45 patients in c-TACE group. During the follow-up period, all patients received 2-4 times of TACE therapy. At the first time of TACE treatment, 79 patients underwent superselective hepatic arterial chemoembolization. The technical success rate was 93% (79 / 85). No severe complications such as liver failure, liver abscess and acute cholecystitis occurred during multiple treatment. During the follow-up period, the EM-TACE group received 132times of TACE treatment, 3.3 times per capita, 62 times of postoperative fever, 48 cases of abdominal pain, 37 times of nausea or vomiting. In c-TACE group, there were 151, 3.4, 71, 52, 43 times, respectively. There was no statistical difference between the two groups. Liver function was reexamined 1-7 days after the first TACE. Serum total bilirubin (TBIL), combined with bilirubin (CB) increased or decreased in serum of (ALT), aspartate aminotransferase (AST), albumin (ALB),. But there was no statistical difference between the two groups. There was no significant difference in liver function between 4-6 weeks after last TACE and 1 week before operation. Before the first TACE and 4 to 6 weeks after the last TACE, the AFP decreased significantly in both groups, and the degree of decrease was obvious in the EM-TACE group. Four to six weeks after the first TACE operation, the tumor control was evaluated by CT or MRI, on epigastric enhancement according to m RECIST standard. The number of patients in EM-TACE group and CR,PR,SD,PD group were 2 cases, 20 cases, 16 cases, 2 cases, respectively. The effective rate of (CR PR) was 55.0 and the rate of benefit was (CR PR SD) 95.0; In c-TACE group, there were 0 cases, 15 cases, 26 cases, 4 cases, the effective rate was 33.33, and the benefit rate was 91.11.The difference between the two groups was statistically significant (P0.05). One month after the last TACE, CR,PR,SD,PD in EM-TACE group was 1 case, 18 cases, 17 cases and 4 cases respectively. The effective rate was 47.5%, and the rate of benefit was 90%. In c-TACE group, there were 0 cases, 12 cases, 25 cases, 8 cases, 26.67 and 82.22, respectively. There was statistical difference between the two groups (P0.05). Conclusion Embospher microspheres combined with lipiodol emulsion in the treatment of middle stage liver cancer patients have good tolerance, safety and feasibility, and there is no significant difference from routine treatment. The local control rate of tumor was better than that of conventional lipiodol chemoembolization. When TACE was operated, the effect of targeting embolization was better by using microcatheter super-selective technique, and the injury of normal liver tissue was also alleviated. The prognosis of HCC is related to the BCLC stage, tumor size, tumor number, Child grade and so on. In addition, regular reexamination and follow-up of patients are also important factors affecting prognosis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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