海藻酸钠微球在肝动脉化疗栓塞治疗中晚期原发性肝癌中的疗效研究

Clinical Application of TACE with Sodium Alginate Microballoons(KMG) in the Treatment of Hepatocellular Carcinoma

目的比较海藻酸钠(KMG)微球和明胶海绵颗粒在肝动脉化疗栓塞中的栓塞效能、疗效,并探讨栓塞效能和疗效间的关系。方法接受KMG微球及明胶海绵颗粒栓塞的同质中晚期肝癌患者各50例,分别为实验组和对照组,比较两组患者的栓塞效能(术后1个月瘤灶的碘油沉积率)以及栓塞疗效,并比较栓塞效能与疗效间的关系。结果术后第一个月的碘油沉积率实验组和对照组分别为(81.32±13.322)%和(50.78±19.723)%;差别有统计学意义。2年肝内肿瘤进展率实验组和对照组分别为48%和68%;差异有统计学意义;无进展生存率实验组和对照组分别为46%和26%,有统计学意义。实验组和对照组1年和2年生存率分别82%,72%和60%,38%;差异有统计学意义。实验组和对照组1、2年肝外肿瘤进展率分别2%,4%和20%,30%,有统计学意义。1年肝内肿瘤进展及1年无进展生存率,两组比较无差别。实验组和对照组1年生存率分别为82.2%和33.3%;差异有统计学意义,而无进展生存率分别为74.0%和30.4%;P=0.009,且1年肝内肿瘤进展率分比为4.1%和29.6%;P<0.001,肝外肿瘤进展率实验组和对照组分别为0.31%vs 35.5%;P<0.001。结论 KMG微球治疗应用于肝动脉化疗栓塞术中治疗原发性肝癌安全,患者耐受良好;作为栓塞剂,较之明胶海绵颗粒,能取得更优的近期以及远期疗效。肿瘤灶中碘油的沉积率作为栓塞效果的指标,碘油沉积率较高的肝癌患者其预后往往更优于乏碘油沉积的肝癌患者。

Objective To compare the efficacy of TACE with Sodium Alginate Microballoons （ KMG） in the treatment of hepatocellular carcinoma （ HCC） ,and evaluate the correlation between embolization efficacy and treatment effectiveness .Methods A case-controlled study was undertaken with 100 patients with middle and advanced HCC and divided into the experimental group and conditional control group ,each with 50 cases,embolization efficacy （ Lipiodol retention within tumor at 1 months after TACE） and treatment effectiveness were evaluated , correlation between embolization efficacy and treatment effectiveness were compared.Results Lipiodol retention was greater in the KMG-TACE group （81.32%±13.322%vs 50.78%±19.723%;P〈0.001）.The intrahepatic disease progression at 2 year was higher in the Gelfoam-TACE group （68% vs 48%;P=0.043） and the 2-year progression-free survival was higher in the KMG-TACE group （46% VS 26%;P=0.037）.1-and 2-year overall sur-vival rates were higher in the KMG-TACE group （82%and 72%,respectively,vs 60%and 38%;P〈0.05）.1-and 2-year extra-hepatic disease progression rates were lower in the KMG-TACE group （P〈0.005）.There were no differences in progression-free survival and intrahepatic disease progression rates at 1 year.Patients with greater Lipiodol retention （ 〉60%） had better treat-ment outcomes at 1 year than those with lesser retention ,with higher overall survival rates （82.2%vs 33.3%;P〈0.001）,lower intrahepatic disease progression rates （4.1% vs 29.6%;P〈0.001）,lower extrahepatic disease progression rates （0.31% vs 35.5%;P〈0.001）,and higher progression-free survival rates （74.0% vs 30.4%;P=0.009）.Conclusion TACE using KMG micro balls is safe and effective for patients with HCC .In comparison with TACE using gelfoam particles ,TACE using KMG microballoon can overcome the loss of iodinated oil to reinforce the effect of vascular embolism and improve curative effect ,which lead to better vascular embolic efficiency ,and better short-term and long-term efficacy.Embolization efficacy as represented by the degree of Lipiodol retention is a useful early predictor of treatment effectiveness .