重组人血管内皮抑素联合肝动脉灌注化疗栓塞治疗中晚期肝癌的临床应用

Intrahepatic arterial infusion of endostatin combined with transcatheter arterial chemoembolization for the treatment of advanced hepatocellular carcinoma

目的研究重组人血管内皮抑制素(内皮抑素)联合肝动脉TACE治疗中晚期肝癌的临床疗效及安全性。方法选取40例中晚期肝癌患者,随机分成两组。治疗组常规TACE加重组人内皮抑素-碘化油乳剂栓塞;对照组单纯给予常规TACE。所有患者术后1年内不定期复查CT或MRI,以及DSA检查。观察肿瘤复发或转移情况以及有无肿瘤新生血管形成。比较瘤体缩小情况,AFP变化,6个月、1年的生存率以及生活质量。同时比较两组术后不良反应。结果治疗组1年生存率、AFP下降程度显著高于对照组,治疗组与对照组1年生存率分别为75%(15/20)和60%(12/20);AFP下降值平均差为300μg/ml;肿瘤新生血管、转移抑制明显。结论内皮抑素联合TACE治疗中晚期肝癌,患者1年生存率显著提高,AFP下降明显,肿瘤新生血管、转移抑制明显,且安全,具有较好的临床应用前景,值得临床进一步研究。

Objective To investigate the effectiveness and the safety of intrahepatic arterial infusion of recombinant human endostatin combined with transcatheter arterial chemoembolization （TACE） for the treatment of advanced hepatocellular carcinoma. Methods Forty patients with advanced hepatocellular carcinoma were equally and randomly divided into study group and control group. Patients in study group received intrahepatic arterial infusion of recombinant human endostatin together with TACE, while patients in control group received conventional TACE only. Within one year after the treatment, non-scheduled CT （or MRI） and DSA were re-examined. The recurrence or metastasis of the tumor and the formation of tumor angiogenesis were surveyed and assessed. Changes in tumor size and AFP, half- and one-year survival rates, the Living quality as well as the side effects were compared between two groups. Results The one-year survival rate of study group was 75% （15/20）, which was significantly higher than that of control group （60%, 12/20）, with P 〈 0.05. Also, the mean reduction value of AFP in study group was significantly bigger than that in control group （mean difference = 300 μg/ml）. The formation of tumor angiogenesis and the metastasis were markedly inhibited. Conclusion Compared to pure TACE treatment for advanced hepatocellular carcinoma, intrahepatic arterial infusion of recombinant human endostatin combined with TACE can significantly increase the one-year survival rate and reduce AFP level, it can also inhibit both the formation of tumor angiogenesis and the occurrence of metastasis. This treatment is safe and effective, and carries bright clinical prospects. The technique is really worth being further studied.