原发性肝细胞癌抗血管生成治疗后血管内皮生长因子及血流灌注参数变化

Changes of serum vascular endothelial growth factor and perfusion parameters in hepatocellular carcinoma after anti-angiogenic therapy

背景血管靶向药物是临床治疗肝脏肿瘤所取得的重大进步之一,尤其对于不能行手术切除的晚期原发性肝细胞癌(hepatocellular carcinoma, HCC)患者,其疗效确切.超声造影是一种无创性血流灌注显示方法,能实时动态反映肿瘤组织的微循环血流灌注,可为临床评估HCC抗血管生成疗效提供血流动力学参考信息.目的探讨超声造影在评估HCC抗血管生成疗效中的应用价值.方法选取经肝穿刺活检病理证实的72例HCC患者作为研究对象(共72个病灶),随机分为A组(36例)和B组(36例). A组接受经肝动脉化疗栓塞术(transcatheterarterial chemoembolization, TACE)治疗, B组接受TACE联合沙利度胺治疗.所有患者分别于治疗前、治疗12 wk后行超声造影检查,测量病灶血流灌注参数:曲线下面积(area under curve, AUC)、峰值强度(peak intensity, PI),同期测定血清血管内皮生长因子(vascular endothelial growth factor, VEGF)水平作比较分析.结果B组治疗后AUC、PI以及血清VEGF水平分别低于各组治疗前,差异有统计学意义(P <0.05);B组治疗后AUC、PI以及血清VEGF水平明显低于A组治疗后,差异有统计学意义(P <0.05).结论超声造影能定量分析HCC抗血管生成治疗后血流灌注参数变化,有效评估HCC抗血管生成疗效,具有一定应用价值.

BACKGROUND Vascular targeting drugs are one of the major advances in the treatment of liver tumors, especially for patients with advanced hepatocellular carcinoma (HCC) which cannot be resected surgically. Contrast-enhanced ultrasound is a non-invasive method for displaying perfusion. It can dynamically reflect microcirculation perfusion of tumor tissue in real time and provide hemodynamic information for clinical evaluation of anti-angiogenic effect on HCC. AIM To investigate the value of contrast-enhanced ultrasound in evaluating the effect of anti-angiogenic therapy in HCC. METHODS Seventy-two patients with HCC (72 lesions) confirmed by pathology were randomly divided into either group A (36 cases) or group B (36 cases). Group A received transcatheter arterial chemoembolization (TACE). Group B received TACE combined with thalidomide. All patients were examined by contrast-enhanced ultrasound before treatment and 12 weeks after treatment. The parameters of blood perfusion including area under curve (AUC) and peak intensity (PI) were measured. Meanwhile, the levels of serum vascular endothelial growth factor (VEGF) were measured and compared.RESULTS The AUC, PI, and serum levels of VEGF after treatment were significantly lower than those before treatment in both groups A and B (P < 0.05), and these parameters after treatment were significantly lower in group B than in group A (P < 0.05). CONCLUSION Contrast-enhanced ultrasound can quantitatively analyze the changes of blood flow perfusion after anti-angiogenic therapy of HCC and effectively evaluate the effect of antiangiogenic therapy in this malignancy.