肝动脉化疗栓塞术中植入氟尿嘧啶、奥沙利铂、吡柔比星治疗中晚期原发性肝癌的临床研究

Clinical Research of Implanting Fluorouracil, Oxaliplatin and Pirarubicin during Transcatheter Arterial Chemoembolization(TACE)for Treatment of Middle and Advanced Primary Hepatocellular Carcinoma

目的研究肝动脉化疗栓塞术(TACE)中植入氟尿嘧啶、奥沙利铂和吡柔比星治疗中晚期原发性肝癌(PHC)的临床效果。方法选择中晚期PHC患者68例,按照随机数字表法分为联合组与对照组,每组各34例。联合组患者行TACE治疗,术中植入氟尿嘧啶、奥沙利铂和吡柔比星;对照组患者行肝动脉栓塞(TAE)治疗。观察两组治疗前后甲胎蛋白(AFP)、E-钙粘连蛋白(EC)、内皮抑素(E)、VEGF和免疫细胞水平、无进展生存期、总生存期、临床疗效及不良反应。结果治疗后,联合组AFP、EC、E、VEGF水平均低于对照组,差异有统计学意义(P<0.05);联合组CD3+、CD4+、CD4+/CD8+水平均高于对照组,CD8+水平低于对照组,差异均有统计学意义(P<0.05);联合组无进展生存期、中位无进展生存期均高于对照组,差异有统计学意义(P<0.05);除恶心、呕吐外,联合组其他不良反应与对照组比较,差异无统计学意义(P>0.05)。结论 TACE术中植入氟尿嘧啶、吡柔比星及奥沙利铂可有效杀灭肝癌细胞,改善患者免疫水平及远期疗效,减少不良反应。

Objective To study the clinical effects of implanting fluorouracil,oxaliplatin and pirarubicin during transcatheter arterial chemoembolization（TACE）for treatment of middle and advanced primary hepatocellular carcinoma（PHC）;Methods 68 cases of middle and advanced PHC patients were randomized into combined treatment group（n=34）and control group（n=34）.Patients of combined treatment group were treated with TACE and implanted fluorouracil,oxaliplatin and pirarubicin during the treatment.Patients of control group were treated with Transcatheter Arterial Embolization（TAE）.The levels of alpha fetoprotein（AFP）,E-cadherin（EC）,endostatin（E）,VEGF,immune cells,progression free survival,overall survival,clinical effects and untoward effect of the two groups were observed before and after the treatment.Results After treatment,the levels of AFP,EC,E and VEGF of the combined treatment group were all significantly lower than those of the control group（P〈0.05）.Levels of CD3＋,CD4＋ or CD4＋/CD8＋ of combining group were higher than those of control group（P〈0.05）and Level of CD8＋ was lower than that of control group,the differences were statistically significant（P〈0.05）.Progression free survival and median progression free survival of combining group were higher than those of control group（P〈 0.05）;except for nausea and emesis,other untoward effects of combining group had no statistically significant differences when compared to those of control group（P〉 0.05）.Conclusion Infusing fluorouracil,pirarubicin and oxaliplatin during TACE can effectively kill HCC cells,improve immune level and longterm efficacy in patients and reduce untoward effects,thus the therapy is worthy of clinical application.