立体定向放射治疗对原发性肝癌患者肿瘤标志物及预后的影响

Effect of stereotactic body radiation therapy on tumor markers and prognosis in patients with primary liver cancer

目的探讨立体定向放射治疗对原发性肝癌患者肿瘤标志物及预后的影响。方法选取福建医科大学孟超肝胆医院2017年1月至2018年6月收治的100例原发性肝癌患者为研究对象,采用随机数表法分为观察组和对照组,各组50例。对照组患者予以射频消融疗法,观察组患者予以立体定向放射疗法,治疗2个月比较两组患者的疗效、不良反应,以及治疗前后肿瘤标志物血清甲胎蛋白(AFP)、α-L-岩藻糖苷酶(AFU)、糖类抗原19-9(CA19-9)水平。治疗后完成3年的随访,绘制生存曲线,并采用Cox回归分析随访期死亡的危险因素。结果治疗2个月后,观察组和对照组患者的总有效率(84%vs 80%)和控制率(96%vs 90%)比较差异均无统计学意义(P>0.05);治疗2个月后,观察组患者的胃肠道反应和肝区不适的发生率明显低于对照组,转氨酶异常发生率明显高于对照组,差异均有统计学意义(P<0.05),但两组患者的发热与血小板异常的发生率比较差异均无统计学意义(P>0.05);治疗前,两组患者的AFP、AFU、CA19-9水平比较差异均无统计学意义(P>0.05);治疗后,两组患者的AFP、AFU、CA19-9水平均降低,且观察组明显低于对照组,差异均有统计学意义(P<0.05);随访3年,两组患者的复发、转移及死亡率比较差异均无统计学意义(P>0.05),但观察组患者的中位总生存期(OS)和中位无进展生存期(DFS)分别为(17.15±1.26)个月、(16.57±1.43)个月,明显长于对照组的(15.39±1.27)个月、(14.42±1.34)个月,差异均有统计学意义(P<0.05);Cox回归分析结果显示影响患者预后的因素主要是治疗方式和病灶数目(P<0.05),其中立体定向放射治疗和单个病灶利于改善患者预后。结论立体定向放射治疗能降低原发性肝癌患者肿瘤标志物水平,提高患者生存率,值得临床推广应用。

Objective To investigate the effect of stereotactic body radiation therapy on tumor markers and prognosis in patients with primary liver cancer.Methods One hundred patients with primary liver cancer treated in Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2017 to June 2018 were selected as the study subjects.They were randomly divided into the observation group and control group,with 50 patients in each group.Patients in the control group were given radiofrequency ablation therapy,and those in the observation group received stereotactic radiotherapy.After 2 months of treatment,the efficacy,adverse reactions,serum alpha fetoprotein(AFP),tumor markers,α-L-Fucosidase(AFU),and carbohydrate antigen 19-9(CA19-9)levels before and after treatment were compared between the two groups.After 3 years of follow-up after treatment,the survival curve was drawn,and the risk factors of death during follow-up were analyzed by Cox regression.Results After 2 months of treatment,there was no significant difference in the total effective rate(84%vs 80%)and control rate(96%vs 90%)between the observation group and the control group(P>0.05).After 2 months of treatment,the incidence of gastrointestinal reactions and liver discomfort in the observation group was significantly lower than that in the control group,and the incidence of transaminase abnormalities was significantly higher than that in the control group(P<0.05);However,there was no significant difference in the incidence of fever and platelet abnormalities between the two groups(P>0.05).After treatment,AFP,AFU,CA19-9 levels were reduced in both groups,and the levels in observation group was significantly lower than the control group,with statistically significant differences(P<0.05).After 3 years of follow-up,there was no significant difference in recurrence,metastasis and mortality between the two groups(P>0.05),but the median overall survival(OS)and median progression free survival(DFS)in the observation group were(17.15±1.26)months and(16.57±1.43)months,respectively,which were significantly longer than(15.39±1.27)months and(14.42±1.34)months in the control group(P<0.05).Cox regression analysis showed that the main factors affecting prognosis were the treatment mode and the number of foci(P<0.05),among which stereotactic radiotherapy and individual lesions can help to improve patient’s prognosis.Conclusion Stereotactic body radiation therapy can reduce the level of tumor markers,and improve the survival rate of patients with primary liver cancer,which is worthy of clinical application.