肝动脉化疗栓塞联合局部抗血管生成治疗中晚期肝癌的临床研究

Transcatheter Hepatic Arterial Chemoembolization Combined with Local Antiangiogenic Therapy in Advanced Hepatocellular Carcinoma

目的探讨肝动脉化疗栓塞（TACE）联合局部动脉内重组人血管内皮抑制素（恩度）治疗中晚期肝癌血清血管内皮生长因子（VEGF）改变、疗效及不良反应。方法56例中晚期原发性肝癌患者分为两组。试验组28例，予TACE联合局部动脉内恩度治疗；对照组28例，予常规TACE治疗。分别于术前1周内及术后3、7、28天检测血清VEGF及甲胎蛋白（AFP）水平、术前1周内及术后1个月患者增强CT或MRI图像比较两组治疗实体肿瘤疗效及不良反应并进行分析。结果试验组和对照组术后7天血清VEGF水平分别为：（12．9±5．23）ng/ml、（13．1±4．26）ng／ml，对照组术后7天VEGF水平较术前明显增高，有统计学意义（t=-4．39，P=0．000），而试验组术后与术前血清VEGF水平比较无显著差异。两组术前血清AFP分别为：（601．3±372）ng/ml、（800．5±190．34）ng/ml。术后3～4周AFP分别为：（606．3±332．76）ng/ml、（656±313．19）ng/ml，与术前比较均无显著差异（P〉0．05）。试验组治疗后实体肿瘤缓解总有效率96％；对照组总有效率79．3％，试验组总有效率明显高于对照组，有统计学意义（P=0．000）；试验组患者术后平均生存时间12．9个月，对照组平均生存时间14．9个月。TA—CE后两组患者均有不同程度栓塞后综合征发生，未发现试验组有明确与恩度相关的并发症发生。结论TACE联合局部抗血管生成治疗中晚期原发性肝癌安全可靠，对肿瘤的局部控制率较传统单纯TACE组为优。

Objective To investigate the serum levels of vascular endothelial growth factor（VEGF）, efficacy and safety of transcatheter arterial chemoembolization（TACE）plus endostar on advanced hepatocellular carcinoma（HCC）. Methods Fifty-six patients with advanced HCC were assigned to receive TACE combined with intra - arterial endostar infusion （ ex- perimental group, n = 28 ） or TACE alone （ control group, n = 28 ）. The serum levels of vascular endothelial growth factor （VEGF） ,alpha-fetoprotein（AFP）were collected pre- procedure and on the third, seventh and twenty-eighth day of the post procedure and the tumor size was compared on the dual-phase enhanced CT or MRI images which performed 1 week before procedure and 1 month after the procedure. Therapeutic and adverse effects were analyzed. Complications post proce- dure were recorded. The survival time after the first TACE were followed up. Results The serum VEGF level of the ex- perimental and control groups on d7 post procedure were （ 12.9 ± 5.23 ） and （ 13.1 ± 4.26） ng/ml, and it was elevated significantly on d7 compared with preprocedure in the control group （ t = -4. 39 ,P =0.000）, but no difference in the con- trol group. The changes of serum AFP between the two groups were no statistically different （P 〉 0.05 ）. Total effective rates of the two groups were 96% and 79.3% respectively, and the difference between the two groups was statistically sig- nificant （P = 0. 000）. There were no obvious adverse effects observed between the two groups. Conclusion TACE com- bined with Endostar should be an safe and effective method which can control the local lesions better in advanced HCC com- pared to the traditional TACE procedure.