不同方式TACE治疗不可切除肝癌的疗效及安全性分析

Efficacy and safety of transcatheter arterial chemoembolization with drug-eluting beads in treatment of unresectable hepatocellular carcinoma

目的探讨载药微球经导管动脉化疗栓塞术(DEB-TACE)与传统经导管动脉化疗栓塞术(TACE)治疗不可切除肝癌的疗效及安全性。方法选取2016年10月至2019年9月在合肥市第二人民医院接受TACE治疗的不可切除肝癌患者76例,其中接受DEB-TACE治疗32例(观察组),接受传统TACE治疗44例(对照组)。比较两组患者疗效、血清肿瘤标志物、肝功能指标、不良反应发生率和远期生存的差异,Cox回归分析远期生存的影响因素。结果治疗后1、3、6个月时,两组患者疾病缓解率和疾病控制率比较差异均无统计学意义(均P>0.05)。两组患者治疗后血清甲胎蛋白(AFP)、血管内皮生长因子(VEGF)水平均呈下降趋势(均P<0.05),其中治疗前后血清AFP水平组间比较差异均无统计学意义(均P>0.05);而观察组患者治疗后各时间点血清VEGF水平均低于对照组(均P<0.05)。两组患者治疗前后血清ALT、AST水平比较差异均无统计学意义(均P>0.05)。治疗后两组患者发热、腹痛、使用镇痛药、局部胆道损伤、WBC减少的发生率比较差异均无统计学意义(均P>0.05)。观察组患者中位生存期为41个月,高于对照组的25个月,差异有统计学意义(P<0.05)。Cox回归分析显示,DEB-TACE治疗是远期生存的保护因素(OR=1.585,95%CI:1.241~1.944,P<0.05),门静脉癌栓(OR=0.686,95%CI:0.502~0.812)、治疗后1周VEGF水平升高(OR=0.734,95%CI:0.562~0.837)是远期生存的危险因素(均P<0.05)。结论与传统TACE比较,DEB-TACE治疗不可切除肝癌具有更为理想的远期疗效及确切的安全性。

Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization with drug-eluting beads(DEB-TACE)in the treatment of unresectable hepatocellular carcinoma.Methods Seventy-six patients with unresectable hepatocellular carcinoma admitted in the Second People’s Hospital of Hefei from October 2016 to September 2019 were enrolled in the study.Among them,32 cases were treated with DEB-TACE(study group)and 44 cases were treated with conventional TACE(control group).The curative effect,serum tumor markers,liver function,adverse reactions and long-term survival between the two groups were compared,and the influencing factors of long-term survival were analyzed by Cox regression.Results There were no significant differences in remission rate and disease control rate at 1,3,6 months after treatment between two groups(all P>0.05).The serum contents of AFP and VEGF in the two groups showed a downward trend after therapy(all P<0.05),the difference of serum contents of AFP had no statistical significance(P>0.05),however,the VEGF levels of study group were lower than those of control group(P<0.05).The difference of serum contents of ALT and AST after treatment had not statistical significance between two groups(P>0.05).There were no significant differences in the incidence of fever,abdominal pain,analgesics use,local bile duct injury,and leukopenia after treatment between two groups(all P>0.05).The median survival time of the study group was significantly higher than that of the control group(41 months vs 25 months,P<0.05).Cox regression analysis showed that DEB-TACE was a protective factor for long-term survival(OR=1.585,95%CI:1.241-1.944,P<0.05),while portal vein tumor thrombus(OR=0.686,95%CI:0.502-0.812),and increased VEGF level 1 week after therapy(OR=0.734,95%CI:0.562-0.837)were risk factors for long-term survival(both P<0.05).Conclusion Compared with conventional TACE,DEB-TACE has better long-term efficacy and safety in the treatment of unresectable hepatocellular carcinoma.