高强度聚焦超声消融治疗中晚期原发性肝癌的疗效分析

Analysis of the Efficacy of High-intensity Focused Ultrasound Ablation in the Treatment of Intermediate and Advanced Primary Hepatic Cancer

目的 探究高强度聚焦超声(HIFU)消融治疗中晚期原发性肝癌(PHC)的临床效果。方法 选取2020年12月—2021年4月收治100例中晚期PHC的临床资料,根据治疗方案不同分为对照组和研究组,每组50例。对照组采用肝动脉化疗栓塞术(TACE)治疗,研究组采用HIFU消融联合TACE治疗。比较2组临床疗效、血清肿瘤标志物[趋化因子9(CXCL9)、糖类抗原199(CA199)、热休克蛋白90(HSP90)]、抑癌基因[清道夫受体A5(SCARA5)、细胞周期依赖性蛋白激酶抑制剂(P16)]蛋白水平、动态增强磁共振成像参数[转运常数(K~(trans))、容积分数(V_e)、速率常数(K_(ep))]、肝区疼痛数字等级量表(NRS)评分、生存质量Karnofsky功能状态量表(KPS)评分及生存率。结果 研究组临床总缓解率高于对照组(P<0.05)。治疗后3个月,研究组血清CXCL9、CA199、HSP90水平以及NRS评分、K~(trans)、V_e、K_(ep)较对照组低,血清SCARA5、P16蛋白水平以及KPS评分较对照组高(P<0.05)。2组治疗后6个月、9个月和1年生存率比较差异无统计学意义(P>0.05)。结论 HIFU消融联合TACE治疗中晚期PHC疗效确切,能抑制肿瘤进展,上调抑癌基因表达,减轻患者疼痛,从而提高生存质量,具有较高临床应用价值。

Objective To explore the clinical effect of high-intensity focused ultrasound(HIFU)ablation on intermediate and advanced primary hepatic cancer(PHC).Methods The clinical data of 100 patients with intermediate and advanced PHC treated from December 2020 to April 2021 were selected and divided into control group(n=50)and research group(n=50)according to different treatment plans.The control group was treated with transcatheter arterial chemoembolization(TACE),and the research group was treated with HIFU ablation combined with TACE.Clinical efficacy,serum tumor markers[chemokine 9(CXCL9),carbohydrate antigen 199(CA199),heat shock protein 90(HSP90)],tumor suppressor gene[scavenger receptor(SCAR)A5,cycledependent protein kinase inhibitor(P16)]protein levels,dynamic enhanced magnetic resonance imaging parameters[Ka transfer(K trans),volume fraction(V e),Rate constant(K ep)],numeric rating scale(NRS)score of hepatic pain,quality of life Karnofsky Performance Scale(KPS)score and survival rate were compared between the two groups.Results The total clinical remission rate of the research group was higher than that of the control group(P<0.05).At 3 months after treatment,the levels of serum CXCL9,CA199 and HSP90 as well as the NRS score,K trans,V e and K ep in the research group were lower than those in the control group,while the levels of serum SCARA5,P16 protein and KPS score in the research group were higher than those in the control group(P<0.05).There was no significant difference in 6-month,9-month and 1-year survival rates between the two groups after treatment(P>0.05).Conclusion HIFU ablation combined with TACE has definite efficacy in the treatment of intermediate and advanced PHC,which can inhibit tumor progression,up-regulate the expression of tumor suppressor genes,and reduce patients'pain,thus improving the quality of life.It has high clinical application value.