不同剂量化疗药物经动脉栓塞术对肝癌患者肝纤维化及预后的影响

Effect of transcatheter arterial chemoembolization with low or conventional dosage on the fibrosis and prognosis in patients with hepatocellular carcinoma

目的：对照分析小剂量和常规剂量化疗药物经动脉化疗栓塞术（TACE）对肝细胞癌（HCC）患者血清肝纤维化指标和疗效的影响。方法：对50例HCC患者行TACE,其中小剂量组（n=25）给予小剂量化疗药物,常规剂量组（n=25）给予常规剂量化疗药物。分别检测患者TACE术前、术后7 d血清透明质酸（HA）、人Ⅲ型前胶原（hPC-Ⅲ）、层黏连蛋白（LN）、Ⅳ型前胶原（Ⅳ-C）,同时观察近期客观疗效和生存期。结果：TACE术前血清肝纤维化指标两组间均无显著性差异,常规剂量组术后各项指标均明显高于术前（P〈0.05）,小剂量组术后各项指标与术前比均无显著性差异（P〉0.05）。术后两组间差值比较出现显著性差异（P〈0.01）。小剂量组与常规剂量组中位生存期分别为19.2个月（95%C I,10-31个月）、18.5个月（95%C I,8-28个月）,两组的1和2年生存率分别为60.9%、40.1%和58.8%、39.5%,无显著性差异（P〉0.05）。结论：应用小剂量化疗药物行TACE术治疗肝癌可能减轻患者术后早期肝纤维化程度,且对客观疗效和生存期无影响。

Objective： To study the changes of serum fibrosis indicators and therapeutic effects after transcatheter arterial chemoembolization （TACE） with low-and conventional-dose chemotherapeutic agents in hepatocellular carcinoma （HCC）. Methods：Fifty patients with HCC underwent TACE with low-dose anticancer agent in Group A （n = 25） and at conventional-dose in Group B （n = 25）. Four ser- um fibrosis indicators, hyaluronic acid （HA）, human procollagen type-HI （hPC-111 ）, laminin （LN） and collagen type-IV （ IV-C）, were assessed before and 7 days after TACE. The therapeutic effects and survival time were compared respectively. Results：There were no significant differences between the two groups in the four indicators before TACE. After TACE, the concentrations of the four serum indicators were increased significantly in Group B （ P 〈0. 05 ）, but not significantly different from preoperation in Group A （ P 〉 0.05 ）. Significant differences were observed in differential value between the two groups after TACE （P 〈0.01 ）, butnot in the median survival period and overall survival rate at 1 and 2 years （ P 〉 0.05 ）. Conclusion ： TACE with low-dose anticancer agents may reduce the progress of liver fibrosis and have no influence on median survival time in HCC.