胸苷激酶1在非小细胞肺癌^(125)I粒子植入治疗疗效评估中的价值

Value of Thymidine Kinase-1 in Evaluation of ^(125)I Seed Implantation for Non-Small Cell Lung Cancer

目的测定^(125)I粒子植入治疗前后非小细胞肺癌患者血清胸苷激酶1(TK1)水平,探讨血清TK1检测在非小细胞肺癌^(125)I粒子植入治疗疗效评估中的意义。方法对48例经病理确诊为非小细胞肺癌患者行CT引导下放射性^(125)I粒子植入治疗,治疗后随访6个月,定期复查胸部CT,根据实体瘤治疗疗效评价标准进行疗效评价。分别于治疗前3d及治疗后1、2、3、6个月取患者静脉血,检测各时点血清TK1水平,比较不同疗效评级植入治疗前后血清TK1水平的变化。结果全部患者均顺利完成放射性^(125)I粒子植入治疗。随访6个月,48例患者完全缓解(CR)9例(18.7%),部分缓解(PR)27例(56.3%),疾病稳定(SD)7例(14.6%),疾病进展(PD)5例(10.4%),治疗总有效率为75.0%,无死亡病例发生。48例患者治疗后1、2、3、6个月血清TK1水平均较治疗前显著下降(P<0.05)。CR、PR组各时点TK1水平与SD、PD组比较,均显著降低(P<0.05);CR、PR患者植入治疗后各时点TK1水平比较差异均有统计学意义(P<0.05),SD患者植入治疗后3、6个月TK1水平比较差异无统计学意义(P>0.05),PD患者植入治疗后2、3、6个月TK1水平比较差异均无统计学意义(P>0.05)。结论 ^(125)I粒子植入治疗能有效地抑制和杀灭肿瘤细胞,可作为中晚期非小细胞肺癌治疗的有效手段。血清TK1水平可反映术后病情变化情况,尤其在早期疗效评价中有较好的敏感性,可作为监测^(125)I粒子植入治疗非小细胞肺癌的评估指标。

Objective To detect the levels of serum thymidine kinase-1（TK1）before and after^125I seed implantation for non-small cell lung cancer（NSCLC）,and to investigate the significance of TK1 detection in evaluation of treatment outcomes of ^125I seed implantation.Methods Fortyeight patients with pathologically confirmed NSCLC received CT-guided implantation of radioactive ^125I seeds,and were followed up for 6 months after treatment.Chest CT was regularly performed,and the outcomes were evaluated according to the response evaluation criteria in solid tumors.Venous blood samples were collected 3days before treatment and 1,2,3and 6months after treatment to measure the levels of serum TK1.Results All patients successfully completed^125I seed implantation therapy.After 6months of follow-up,9patients（18.7%）had complete remission（CR）,27patients（56.3%）had partial remission（PR）,7patients（14.6%）had stable disease（SD）,and 5patients（10.4%）had progressive disease（PD）.The total effective rate was75.0%,and no death occurred in all patients.Serum levels of TK1 decreased 1,2,3and 6months after treatment in all patients（P〈0.05）.Compared with SD and PD groups,serum TK1 levels decreased in CR and PR groups at all time points（P〈0.05）.Furthermore,the differences in TK1 levels were significant between CR group and PR group after treatment（P〈0.05）.However,differences in TK1 levels were not significant among different time points after treatment（P〉0.05）.Conclusion Radioactive ^125I seed implantation can inhibit and kill tumor cells,and can be used as an effective treatment for middle-late stage NSCLC.Serum TK1 levels can reflect postoperative condition,and TK1 detection has a high sensitivity in the assessment of early curative effect.Therefore,serum TK1 can be used as an evaluation indicator of treatment outcomes of ^125I seed implantation for NSCLC.