中晚期肝癌患者经导管化疗栓塞治疗后序贯射频消融手术治疗时机的选择

Optimal timing of sequential radiofrequency ablation treatment in patients with advanced liver cancer after receiving transcatheter chemoembolization

目的 探讨中晚期肝癌患者经导管化疗栓塞(TACE)治疗后序贯射频消融手术(RFA)治疗的时机。方法 选取2017年7月至2020年6月河北医科大学第四医院收治的102例中晚期原发性肝癌患者,以随机数字表法分为研究组和对照组,每组51例。对照组TACE后行RFA的时间间隔>7 d,研究组TACE后行RFA的时间间隔≤7 d,治疗后3个月观察效果,并随访12个月。比较两组近期抗肿瘤疗效、病灶内生物学标志基因及血液肿瘤标志物表达、术后并发症发生情况和预后。结果 研究组临床控制率高于对照组(P<0.05)。研究组治疗后的基质金属蛋白酶-11(MMP-11)、Slug mRNA相对表达量均低于对照组(P<0.05),研究组治疗后的基质金属蛋白酶组织抑制因子1(TIMP1)mRNA相对表达量高于对照组(P<0.05)。研究组治疗后的AFP、肿瘤特异性生长因子(TSGF)、碱性成纤维细胞生长因子(BFGF)、细胞缺氧诱导因子-1α(HIF-1α)、核因子κB(NF-κB)均低于对照组(P<0.05)。两组总并发症发生率差异无统计学意义(P>0.05)。两组患者无病生存率、总存活率比较差异均无统计学意义(P>0.05)。结论 中晚期肝癌患者TACE后短时间间隔行RFA治疗可增强近期抗肿瘤疗效,抑制患者病灶内侵袭基因及血液肿瘤标志物表达,安全性及预后良好。

Objective To discuss the optimal timing of sequential radiofrequency ablation(RFA treatment for patients with advanced liver cancer after receiving transcatheter chemotherapy embolization(TACE). Methods A total of 102 patients with advanced primary liver cancer, who were admitted to the Fourth Hospital of Hebei Medical University of China between July 2017 and June 2020, were enrolled in this study. By using random digital table method, the patients were divided into study group and control group with 51 patients in each group. The time interval between RFA and TACE in the control group was>7 days,which in the study group was≤7 days. Three months after treatment, the curative effect was evaluated, and the patients were followed up for 12 months. The short-term anti-tumor efficacy, the expressions of biological marker genes within lesions, the expressions of blood tumor markers, the postoperative complications and the prognosis were compared between the two groups. Results The clinical control rate in the study group was higher than that in the control group(P<0.05). The postoperative relative expression levels of matrix metalloproteinase-11(MMP-11) and Slug mRNA in the study group were remarkably lower than those in the control group(P<0.05).The postoperative relative mRNA expression levels of tissue inhibitor of matrix metalloproteinase 1(TIMP1) mRNA in the study group were prominently higher than those in the control group(P<0.05). The postoperative levels of alpha-fetoprotein(AFP), tumor-specific growth factor(TSGF), basic fibroblast growth factor(BFGF), hypoxiainducible factor-1α(HIF-1α), and nuclear factor κB(NF-κB) in the study were strikingly lower than those in the control group(P<0.05). No statistically significant differences in the total incidence of complications, the disease-free survival rate and the total survival rate existed between the two groups(P>0.05). Conclusion In treating patients with advanced liver cancer, RFA treatment performed at a short interval after TACE treatment can enhance the short-term anti-tumor efficacy, inhibit the expressions of invasion genes within lesions and blood tumor markers, with satisfactory clinical safety and prognosis.(J Intervent Radiol, 2022,31: 908-912)