^(131)I-chTNT治疗中晚期肝癌的初步应用经验

The preliminary experience of ^(131) I-chTNT in the treatment of advanced hepatocellular carcinoma

目的探讨射频消融(Radiofrequency Ablation,RFA)联合(131I)肿瘤细胞核人鼠嵌合单克隆抗体(131I-ch TNT)治疗中晚期肝癌的应用价值及技术方法。方法回顾性分析34例临床或病理确诊原发性肝癌患者的临床资料,根据治疗方式分为对照组(RFA组)22例,研究组(RFA联合131I-ch TNT组)12例,随访时间5~48个月,采用Kaplan-Meier方法进行生存分析,评价安全指标:肝损伤、骨髓毒性及甲状腺损伤;并对研究组术后的复发因素进一步评价。结果 2组资料中位随访时间31个月,研究组中位生存时间43个月,对照组35个月,研究组中位生存期较研究组有延长趋势(P=0.052)。对照组中位PFS时间7个月,研究组23个月,研究组中位PFS时间显著长于对照组(P=0.047)。研究组术后局部复发4例,复发时间为3.5~8.7个月,3例出现新发病灶。研究组术后7 d复查红细胞、血小板未见明显下降,白细胞指数略升高,具有统计学意义。术后7 d ALT、AST明显升高,TBIL轻微升高。与术前相比,ALT、AST的差异有统计学意义。结论对于中晚期肝癌,RFA联合131I-ch TNT治疗能延长肿瘤无进展生存时间,短期疗效优于RFA治疗,但对于病灶直径在5 cm以上的病灶,存在剂量不足,局部容易复发的特点,仍需进一步研究。

Objective To investigate the value of radiofrequency ablation（RFA） combined with Iodine 131I Tumor Necrosis Therapy Monoclonal Antibody（131I-chTNT） for the treatment of advanced hepatocellular carcinoma. Methods The clinical data of 34 hepatocellular carcinoma patients confirmed by clinical treatment or pathology were retrospectively analyzed. Patients were divided into two groups（ RFA group = 22 cases, Combination group = 12 cases） according to the operation method and followed up for 5 -48 months. Survival was estimated with the KapIan-Meier method and the survival curve was compared by log-rank test. Therapeutic safety was also evaluated by liver damage, myelotoxicity and thyroid damage, and further evaluation of the recurrence risk factors for the combination group was conducted. Results Median follow-up time was 31 months. The median survival time in combination group（ n = 43 months） was significantly longer than that of RFA group（ n = 35 months） ,P = 0.052. The median PFS in Combination group（ n = 23 months） was signifi- cantly longer than that of RFA group （ n = 7 months） , P = 0.047. In the combination group, local recurrence was found in 4 cases, and the recurrence time is 3.5 - 8.7 months, and also three patients had new lesions. In the Combination group, postoperative red blood cells and platelets did not have significant decline following 7 days, and the leucocyte index was slightly elevated. The ALT and AST increased significantly, compared with the preoperative data, the differences in ALT and AST had statistical significance. Conclusion For advanced hepatocellular carcinoma, RFA combined with 131I-chT. NT treatment can prolong progression-free survival time, and its short-term curative effect was better than that of RFA therapy alone. For lesions that the diameter were larger than 5 cm, because of the insufficient doses and earlier tumor recurrence, it should be further explored.