TACE联合微波消融与联合125I放射性粒子植入治疗不可切除肝癌合并门静脉癌栓疗效比较

TACE combined with microwave ablation and 125I radioactive seed implantation for the treatment of inoperable liver cancer with portal vein tumor thrombus

目的 探讨经动脉化疗栓塞(TACE)联合微波消融术与联合I放射性粒子植入治疗不可切除肝癌合并门静脉癌栓的疗效。方法 选取2016年2月至2020年3月内蒙古医科大学附属医院收治的84例不可切除肝癌合并门静脉癌栓患者,以随机数字表法分为研究组42例,对照组42例。对照组行TACE联合I放射性粒子植入治疗,研究组行TACE联合微波消融术,治疗后随访12个月。观察两组患者近期抗肿瘤疗效、病灶内生物学标志基因表达情况,以及治疗期间的不良反应,随访期间的预后情况。结果 治疗后两组患者的客观缓解率、临床控制率比较,差异均无统计学意义(均P>0.05)。治疗后两组患者的丝切蛋白-1(CFL1)、B细胞特异性莫洛尼白血病毒插入位点1(BMI-1)、激活转录因子3(STAT3)mRNA相对表达量均低于治疗前(均P<0.05);且研究组患者的mRNA相对表达量均低于对照组(均P<0.05)。治疗后两组患者的Caspase-3、Runx3、p53mRNA相对表达量均高于治疗前(均P<0.05),且研究组患者的mRNA相对表达量均高于对照组(均P<0.05)。对照组患者的骨髓抑制发生率低于研究组(P<0.05),而高血压、蛋白尿、消化道反应发生率两组差异均无统计学意义(均P>0.05)。研究组患者12个月总存活率为51.22%(21/41),对照组为42.50%(17/40),差异无统计学意义(P>0.05)。结论 TACE联合微波消融术、TACE联合I放射性粒子植入这两种治疗方案对不可切除肝癌合并门静脉癌栓患者的疗效、安全性相近,但TACE联合微波消融术可抑制患者病灶内侵袭基因表达、上调抑癌基因表达。

Objective To evaluate the efficacy of transarterial chemoembolization(TACE) combined with microwave ablation(MWA) andI radioactive seed implantation in treating inoperable liver cancer complicated by portal vein tumor thrombus. Methods A total of 84 patients with inoperable liver cancer complicated by portal vein tumor thrombus, who were admitted to the Affiliated Hospital of Inner Mongolia Medical University of China between February 2016 and March 2020, were collected as the research objects.Random digital table method was used to divide the patients into the study group(n=42) and the control group(n=42). The patients of the control group received TACE combined withI radioactive seed implantation,while the patients of the study group received TACE combined with MWA. After treatment, the patients were followed up for 12 months. The short-term anti-tumor efficacy, the expression of biological marker genes within the lesion, the occurrence of adverse reactions during therapeutic course, and the prognosis in the two groups were recorded. Results There were no significant differences in the objective remission rate(ORR)and clinical control rate between the two groups(P>0.05). In both groups, the postoperative mRNA relative expression levels of cofilin-1(CFL1), B-cell specific Moloney leukemia virus insertion site-1(BMI-1), and activating transcription factor 3(STAT3) were remarkably lower than preoperative ones(P<0.05). Besides, the mRNA relative expression levels in the study group were significantly lower than those in the control group(P<0.05). In both groups the postoperative mRNA relative expression levels of Caspase-3, Runx3 and p53were prominently higher than preoperative values(P<0.05), and the postoperative mRNA relative expression levels in the study group were strikingly higher than those in the control group(P<0.05). The incidence of bone marrow suppression in the control group was lower than that in the study group(P<0.05). No statistically significant differences in the incidences of hypertension, proteinuria and digestive tract reactions existed between the two groups(P>0.05). In the study group the 12-month overall survival rate was 51.22%(21/41),which in the control group was 42.50%(17/40), the difference between the two groups was not statistically significant(P>0.05). Conclusion For the treatment of inoperable liver cancer complicated by portal vein tumor thrombus, TACE combined with MWA therapy has similar clinical efficacy and safety as TACE combined withI radioactive seed implantation therapy, but TACE combined with MWA therapy can inhibit the expression of invasion genes within the lesion and up-regulate the expression of tumor suppressor genes.(J Intervent Radiol, 2022, 31: 889-893)