GM-CSF在肝转移瘤患者中的应用价值及影像学分析

Application of GM-CSF and Imaging Analysis in Patients with Liver Metastases

目的 评价持续肝动脉灌注粒细胞巨噬细胞集落刺激因子（GM-CSF）治疗肝转移瘤患者的疗效及应用GM-CSF后的影像学表现.方法 对32例肝转移瘤患者行肝动脉持续灌注GM-CSF.留置肝管行动脉持续灌注GM-CSF 72 h后行肝动脉灌注化疗栓塞,疗程为2～5个周期.观察灌注前后强化CT及数字减影血管造影（DSA）的影像学表现,并对患者的疗效（CR、PR、NC、PD及CR＋PR）进行分析.结果 与术前的上腹部强化CT及DSA造影相比,灌注GM-CSF后强化边缘厚度显著增加（P＜0.05）.32例患者均完成了2～5个周期的治疗,总有效率（CR＋PR）为46.9％,无明显并发症,无一例由于不良反应而中止治疗.结论 GM-CSF可发挥协同抗肿瘤作用,并可促进肝转移瘤周围的炎性细胞浸润.对于乏血供的肝转移瘤患者,行肝动脉持续灌注GM-CSF可为有效的治疗方法.

Objective To evaluate the efficacy of continuous hepatic arterial infusion of granulocyte-macrophage colony-stimulating factor （GM-CSF）in patients with liver metastases, and to estimate the imaging manifestations after GM-CSF infusion.Methods Transcatheter arterial chemoem- bolization was performed after continuous hepatic arterial infusion of GM-CSF for 72 hours in 32 patients with liver metastases treatment for 2-5 cycles. Enhanced CT and DSA imaging manifestations were observed and complete response （CR）, partial response （PR）, no change （NC）, progressive disease （PD）and CR＋PR were recorded in all patients. Results Compared with preoperative imaging features of CT and DSA, the enhanced edge thickness significantly increased after infusion of GM-CSF （P〈 0.05）. All patients underwent 2-5 cycles of treatment and the total effective rate （CR＋PR）was 46.9%. No patients had obvious complications and discontinued treatment due to adverse reactions. Conclusion GM-CSF may play a synergistic antitumor effect and can promote the infiltration of inflammatory cells around the hepatic metastases. Continuous hepatic arterial infusion of GM-CSF is an effective treatment for hepatic metastases in patients with insufficient blood supply.