三维适形放射治疗不同大体肿瘤体积的原发性肝癌患者疗效研究

Survival rates in patients with primary liver cancer and different gross tumor volumes after radiotherapy

目的探讨不同大体肿瘤体积(GTV)的原发性肝癌(PLC)患者放射治疗后生存情况。方法2018年1月~2020年12月我院收治的PLC患者75例,根据GTV的不同将患者分为A组(<125 cm^(3))20例、B组(126~999 cm^(3))37例和C组(>1000 cm^(3))18例,均接受三维适形放射治疗(3DCRT)。采用ELISA法检测血清甲胎蛋白(AFP)、甲胎蛋白异质体L3(AFP-L3)、高尔基体糖蛋白73(GP73)、血管内皮生长因子(VEGF)和基质金属蛋白酶(MMP)水平。结果在治疗后4 w末,A组客观缓解率(ORR)为70.0%,显著高于B组的51.4%或C组的33.3%(P<0.05);A组血清AFP、AFP-L3、GP73、VEGF和MMP水平分别为(121.0±20.8)ng/mL、(5.9±0.9)ng/mL、(62.8±3.5)ng/mL、(265.3±20.4)pg/mL和(60.2±11.7)ng/L,显著低于B组【分别为(133.0±18.1)ng/mL、(6.5±0.7)ng/mL、(71.4±3.2)ng/mL、(296.1±30.9)pg/mL和(72.5±7.3)ng/L,P<0.05】或C组【分别为(143.0±15.3)ng/mL、(6.9±0.8)ng/mL、(78.3±3.7)ng/mL、(320.5±32.7)pg/mL和(85.5±15.6)ng/L,P<0.05】;A组1 a累积生存率为72.2%(13/18),显著高于B组的52.9%(18/34)或C组的41.2%(7/17,P<0.05)。结论采用3DCRT治疗PLC患者近期有效,但需考虑GTV的影响,GTV越小,近期疗效越好,值得进一步研究。

Objective The aim of this study was to investigate the survival of patients with primary liver cancer(PLC)and different gross tumor volume(GTV)after radiotherapy three-dimensional conformal radiotherapy(3DCRT).Methods 75 patients with PLC were encountered in our hospital between January 2018 and December 2020,and were divided into group A(n=20,<125 cm^(3)),group B(n=37,126-999 cm^(3))and group C(n=18,>1000 cm^(3))based on different GTV.All patients received 3DCRT.Serum alpha-fetoprotein(AFP),alpha-fetoprotein heterogeneity L3(AFP-L3),Golgi protein 73(GP73),vascular endothelial growth factor(VEGF)and matrix metalloproteinase(MMP)levels were detected by ELISA.Results At the end of 4 weeks after treatment,the objective response rate(ORR)in group A was 70.0%,significantly higher than 51.4%in group B or 33.3%in group C(P<0.05);serum AFP,AFP-L3,GP73,VEGF and MMP levels in group A were(121.0±20.8)ng/mL,(5.9±0.9)ng/mL,(62.8±3.5)ng/mL,(265.3±20.4)pg/mL and(60.2±11.7)ng/L,significantly lower than[(133.0±18.1)ng/mL,(6.5±0.7)ng/mL,(71.4±3.2)ng/mL,(296.1±30.9)pg/mL and(72.5±7.3)ng/L,respectively,P<0.05]in group B or[(143.0±15.3)ng/mL,(6.9±0.8)ng/mL,(78.3±3.7)ng/mL,(320.5±32.7)pg/mL and(85.5±15.6)ng/L,respectively,P<0.05]in group C;the one-year cumulative survival rate in group A was 72.2%(13/18),significantlyhigher than 52.9%(18/34)in group B or 41.2%(7/17,P<0.05)ingroup C.Conclusion The short-term efficacy of patients with PLC after 3DCRT treatmentmight be related to the GTV,and needs further clinical investigation.