小剂量与常规剂量化疗药物经导管栓塞化疗对肝癌患者血清肝纤维化指标的影响

A comparative study on the changes of serum fibrosis indicators after TACE with use of low-dose versus con- ventional-dose of anticancer drugs in hepatocellular carcinoma

目的 比较应用小剂量和常规剂量化疗药物经导管栓塞化疗 (TACE)对肝细胞癌 (HCC)患者血清肝纤维化指标的影响。方法 将 4 0例HCC患者分为两组分别行选择性TACE。A组 (n =2 0 )给予小剂量化疗药物 :肿瘤 <5cm者给予丝裂霉素 (MMC) 2～ 4mg;肿瘤在 5～ 8cm之间者给予MMC 4～ 6mg ,表阿霉素 (EPI) 1 0mg ;肿瘤 >8cm时 ,给予MMC 6～ 8mg ,EPI1 0mg ,卡铂 (CBP) 1 0 0mg。B组 (n =2 0 )给予常规剂量化疗药物 (MMC 1 0mg ,CBP 30 0mg ,EPI 4 0mg)。经导管向供血动脉内注入碘油、化疗药物乳化剂 ,随后用明胶海绵粒或PVA微球栓塞该动脉。TACE前、后 7d分别检测患者血清肝纤维化 4项指标 ,包括透明质酸 (HA)、人Ⅲ型前胶原 (hPC Ⅲ )、层粘蛋白 (LN)、Ⅳ型前胶原 (Ⅳ C)。结果 TACE前两组间各项指标均差异无显著性 ,B组TACE后血清各项指标均明显高于术前 (P <0 .0 5 ) ,而A组术后各项指标均与术前差异无显著性 (P >0 .0 5 )。结论 HCC行TACE后肝纤维化形成与术中化疗药物用量有关 。

Objective To study the changes of serum fibrosis indicators after transcatheter arterial chemoembolization (TACE) with the use of low dose vs conventional dose of anticancer drugs in hepatocellular carcinoma (HCC). Methods Forty patients with HCC were divided into two groups to receive superselective TACE. Patients in group A( n =20) received low dose anticancer drug(s):2-4 mg mitomycin C (MMC) with the tumor mass less than 5 cm in size; while MMC 4-6 mg and epirubicin (EPI) 10 mg were given with tumon size of 5-8 cm in diameter, and MMC 6-8 mg, EPI 10 mg, CBP 100 mg with tumors larger than 8 cm. Patients in group B ( n =20) were given conventional dose of anticancer drugs (MMC 10 mg, EPI 40 mg and CBP 300 mg). Lipiodol anticancer drugs emulsion was injected into the feeding arteries of tumors and followed by gelatin sponge or PVA particles embolization participation. Four serum fibrosis indicators, including hyaluronate acid (HA), human procollagen type Ⅲ (hPC Ⅲ), laminin (LN), collagen type Ⅳ(Ⅳ C) were assessed before and 7 days after TACE. Results There was no significant difference between the two groups concerning the four indicators before TACE, but the concentrations of the four serum indicators were increased siginificantly in group B ( P <0.05) after TACE. On the contrary, the differences of the four indicators before and after TACE were not significant in group A ( P >0.05). Conclusions The formation of liver fibrosis after TACE in HCC is related to the dosage of anticancer drugs employed for chemoembolization. Therefore, low dose anticancer drugs should be advocated.