重组人p53腺病毒联合经肝动脉化疗栓塞治疗不同p53表达的中晚期肝细胞癌

Recombinant adenovirus-p53 gene therapy combined with transcatheter arterial chemoembolization for p53-positive and p53-negative hepatocellular carcinoma

目的观察重组人p53腺病毒(rAd-p53)基因联合经导管动脉栓塞化疗术(TACE)治疗不同p53表达的中晚期肝细胞癌的临床疗效。方法 rAd-p53注射液联合TACE治疗中晚期肝细胞癌患者共60例(治疗组),其中p53表达阳性、阴性各30例;同期接受常规TACE治疗的中晚期肝细胞癌患者60例(对照组),p53表达阳性、阴性各30例,并分别比较p53表达阳性和阴性的治疗组与对照组的疗效;同时检测各组患者治疗前后血管内皮生长因子(VEGF)水平,并进行比较。结果 p53表达阳性患者中,治疗组有效率为73.33%,明显高于对照组的46.67%(P<0.05);治疗前后VEGF升高的幅度比较,治疗组小于对照组(P<0.05)。p53表达阴性患者中,治疗组及对照组有效率分别为66.67%和60.00%,差异无统计学意义(P>0.05);治疗组与对照组治疗前后VEGF升高的幅度差异较亦无统计学意义(P>0.05)。结论 rAd-p53注射液联合TACE治疗中晚期肝细胞癌,能够提高p53表达阳性的患者的疗效,并能有效抑制TACE术后VEGF升高的幅度。

Objective To evaluate the clinical effect of recombinant adenovirus-p53（rAd-p53）gene combined with transcatheter arterial chemoembolization（TACE）in patients with advanced hepatocellular carcinoma（HCC）.Methods Sixty patients with advanced HCCM,30 patients with p53 expression-positive and 30 with p53 expression-negative,were treated with rAd-p53 combined with TACE（therapy group）.Another 60 patients with advanced HCC,30 patients with p53 expression-positive and 30 with p53 expression-negative,were treated with TACE of the corresponding period（control group）.The clinical effect of therapy group and control group with different expression of p53 was compared,and the level of vascular endothelial growth factor（VEGF）before and after therapy was measured and compared respectively.Results In p53-positive patients,the effective rate of therapy group（73.33%）was higher than that of control group（46.67%）（P0.05）.The increase range of VEGF in therapy group was lower than that in control group（P0.05）.In the p53-negative patients,the effective rate in therapy group and control group was 66.67% and 60.00%,respectively（P0.05）.The increase range of VEGF before and after therapy had no statistical difference between therapy group and control group（P0.05）.Conclusion In the therapy of advanced hepatocellular carcinoma,rAd-p53 combined with TACE can increase the clinical effect of the p53-positive patients and can inhibit the increase range of VEGF after TACE as well.