碘化油化疗药物乳剂联合D-TACE对比cTACE治疗肝细胞癌的临床价值

Iodized oil chemotherapeutic drug emulsion combined with D-TACE versus c-TACE in the treatment of hepatocellular carcinoma: analysis its clinical value

目的 比较碘化油化疗药物乳剂联合载药微球经动脉化疗栓塞(D-TACE)和常规TACE(cTACE)治疗肝细胞癌(HCC)患者的有效性和安全性。方法 纳入接受碘化油化疗药物乳剂联合D-TACE或cTACE治疗的HCC患者146例。57例患者作为实验组,采用碘化油化疗药物乳剂联合D-TACE+cTACE治疗,89例患者作为对照组,采用cTACE治疗。比较实验组与对照组患者的短期疗效、不良反应等。评估TACE治疗后3个月的治疗反应,并对半年内的治疗次数和治疗间隔进行分析。结果 TACE术后3个月,实验组的疾病控制率为89.50%(51/57),高于对照组的75.30%(67/89),差异有统计学意义(P=0.034);实验组的客观缓解率为56.10%(32/57),对照组为46.10%(41/89),差异无统计学意义(P=0.235)。不良反应情况,呕吐实验组有54例(94.7%),对照组有87例(97.8%);发生肝脓肿实验组有4例(7.0%),对照组有1例(1.1%);炎症反应实验组有8例(14.0%),对照组有6(6.7%);发热实验组有14(24.6%),对照组有17(19.1%),组间比较差异均无统计学意义(均P>0.05);疼痛实验组有36例(63.2%),对照组28例(31.5%),差异有统计学意义(P<0.01)。实验组与对照组6个月内按需治疗的总次数为(2.440±1.095)次和(2.312±0.878)次,差异无统计学意义(P=0.879);首次TACE与补充TACE的时间间隔为57.0 (49.0,90.0)d和55.0(49.0,64.2) d,差异有统计学意义(P=0.045)。结论 碘化油化疗药物乳剂联合D-TACE与cTACE相比,短期疾病控制率更佳,治疗间隔较长,对肝功能的影响及术后不良反应均在可接受范围。

Objective To compare the effectiveness and safety of iodized oil chemotherapy drug emulsion combined with drug-eluting bead(DEB) transarterial chemoembolization(D-TACE) with those of conventional TACE(cTACE) in treating hepatocellular carcinoma(HCC). Methods A total of 146 patients with HCC, who received iodized oil chemotherapy drug emulsion combined with D-TACE or cTACE, were enrolled in this study.The patients were divided into study group(n=57) and control group(n=89). The patients of the study group received iodide oil chemotherapeutic drug emulsion combined with D-TACE+cTACE, while the patients of the control group received cTACE. The short-term efficacy, adverse reactions, etc. were compared between the two groups. The post-TACE 3-month therapeutic response was assessed, The number of treatments and treatment intervals within 6 months were analyzed. Results Three months after TACE, the disease control rate(DCR) in the study group was 89.50%(51/57), which was higher than 75.30%(67/89) in the control group,the difference between the two groups was statistically significant(P=0.034). The objective remission rates(ORR)in the study group and the control group were 56.10%(32/57) and 46.10%(41/89) respectively, the difference between the two groups was not statistically significant(P=0.235). In the study group and the control group, the incidence of vomiting was 94.7%(n=54) and 97.8%(n=87) respectively;the incidence of liver abscess was 7.0%(n=4) and 1.1%(n=1) respectively;the incidence of inflammatory reaction was 14.0%(n=8) and 6.7%(n=6)respectively;the incidence of fever was 24.6%(n=14) and 19.1%(n=17) respectively;the differences in the above indexes between the two groups were not statistically significant(all P>0.05). The incidence of pain in the study group and the control group was 63.2%(n=36) and 31.5%(n=28) respectively;the difference between the two groups was statistically significant(P<0.01). In the study group and the control group, the mean number of TACE treatments within 6 months was(2.440 ±1.095) times and(2.312 ±0.878) times respectively, the difference between the two groups was not statistically significant(P=0.879). The mean time interval between the initial TACE treatment and the supplementary TACE treatment in the study group and the control group was 57.0 days(49.0-90.0 days) and 55.0 days(49.0-64.2 days) respectively, the difference between the two groups was statistically significant(P=0.045). Conclusion Compared with cTACE, iodide oil chemotherapeutic drug emulsion combined with D-TACE+cTACE therapy has certain advantages such as better short-term DCR, longer interval time of treatment, both the influence on liver function and the postoperative adverse reactions being within the acceptable range, etc.