Vascular endothelial growth factor before and after locoregional treatment and its relation to treatment response in hepatocelluar carcinoma patients

Objective:To evaluate vascular endothelial growth factor(VEGF)levels in hepatocellular carcinoma patients before and after transcatheter arterial chemoembolization(TACE)and percutaneous ethanol injection(PEI)and its relation to treatment response.Methods:A total of 40 patients with unrespectable hepatocelluar carcinoma were assessed clinically.Twenty patients were suitable to be treated by TACE,while other 20patients were treated with PEI.Serum VEGF levels were measured before and 1 month after each procedure by ELISA.Response was assessed after 1 month according to Union Internationale Contre le Cancer evaluation criteria based on change in tumor size as measured by ultrasound.Results:There was no significant difference between TACE and PEI groups with regard to age,sex,tumor size,response to local therapy,or VEGF and alpha-fetoprotein before and after therapy.VEGF levels after TACE were significantly higher than before TACE[(298.1±123.6)pg/m L vs.(205.8±307.3)pg/m L;P=0.001].Also,VEGF levels were significantly higher after PEI than before PEI[(333.8±365.6)pg/m L vs.(245.3±301.8)pg/m L;P=0.000].Non-responders of both groups had significantly high VEGF levels than responder's,both before[(985.0±113.2)pg/m L vs.(117.1±75.3)pg/m L;P<0.001]and after therapy[(1 330.6±495.7)pg/m L vs.(171.0±94.7)pg/m L;P=0.000)].Conclusions:Both TACE and PEI were associated with an increase in serum VEGF in hepatocelluar carcinoma patients.Higher levels of VEGF before and after therapy were found in non-responders,suggesting that VEGF is a useful marker in predicting treatment response.

左侧卧位腹腔镜肝右叶部分切除术临床分析

目的探讨左侧卧位腹腔镜肝右叶各肝段部分切除的可行性及疗效。方法回顾性分析右江民族医学院附属医院百东院区2022年5月至2023年4月期间39例行左侧卧位腹腔镜肝右叶部分切除术的病例资料。结果39例中有腹部手术史者13例;肿瘤1个34例,肿瘤2个3例,肿瘤3个2例,肿瘤最大径37.0(24.0,58.0)mm。其中行非解剖性肝切除20例,解剖性肝切除19例;单一肝段切除术28例,两部位肝部分切除术10例,三部位肝部分切除术1例;联合腹腔镜胆囊切除24例;无血流阻断9例,行Pringle法血流阻断30例。平均手术时间(143.5±56.8)min;中位术中出血量100.0(50.0,300.0)mL,4例术中输血(合计29.50 U),无中转开腹。35例放置引流管,引流管留置时间(6.3±3.7)d;术后平均住院时间(10.1±4.0)d,住院总费用(41121.8±18978.3)元。术后23例患者出现少量胸腔积液;1例患者并发急性呼吸窘迫综合征(ARDS)及肝功能不全,经ICU复苏治愈;1例出现少量气胸;无感染、出血、胆漏等并发症发生;无非计划性再次手术发生。所有患者均通过门诊或电话的方式获得随访,所有病例近期无复发。结论左侧卧位行腹腔镜肝右叶部分切除术操作简单,暴露好,手术时间相对较短,出血少。

Meta-analysis on Radiofrequency Ablation in Combination with Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma

To evaluate the efficacy and safety of transcatheter arterial chemoembolization （TACE） combined with radiofrequency ablation （RFA） and TACE alone for hepatocellular carcinoma （HCC）, Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure （CNKI） and Wanfang Datebases were searched for the randomized controlled trials （RCTs） and retrospective cohort studies from the establishment of the databases to January 2014. The bibliographies of the included studies were searched, too. After study selection, assessment, data collection and analysis were under- taken, we performed this meta-analysis by using the RevMan5.2 software. Seventeen studies involving 1116 patients met the inclusion criteria with 530 treated with RFA-plus-TACE and 586 with TACE alone. The results of meta-analysis showed that the combination of TACE and RFA was obviously as- sociated with higher 1-, 2-, and 3-year overall survival rates （OR1-year=3.98, 95% CI 2.87-5.51, P〈0.00001; OR2-year=3.03, 95% CI 2.10-4.38, P〈0.00001; OR3-year=7.02, 95% CI 4.14-11.92, P〈0.00001） than TACE alone. The tumor complete necrosis rate in patients treated with TACE and RFA was higher than that of TACE alone （OR=13.86, 95% CI 8.04-23.89, P〈0.00001）. And there was a significant difference in local recurrence rate between two different kinds of treatment （OR=0.24, 95%CI 0.14-0.44, P〈0.00001）. Additionally, combination of TACE and RFA was associated with higher complete tumor necrosis rates than TACE mono-therapy in the treatment of HCC. However, RFA plus TACE was found to be associated with a lower local recurrence rate than TACE monotherapy TACE-plus-RFA treatment was associated with a higher response rate （RR） than the TACE-alone treat- ment （OR=3.90, 95% CI=2.37-5.42, P〈0.00001）. TACE-plus-RFA treatment did not differ from the TACE-alone treatment in terms of stable disease （SD） rate （OR=0.38, 95% CI=0.11-1.26, P=-0.11）. Meta-analyses showed that the combination of RFA and TACE was associated with a significantly lower progressive disease （PD） rate （OR=0.15, 95% CI=0.05M3.43, P=-0.0005）. The rate of AFP reduc- ing or returning to normal in serum in RFA plus TACE group was obviously lower than TACE alone group （OR=4.62, 95% CI 2.56-8.34, P〈0.00001）. The effect of TACE plus RFA for HCC is better than TACE mono-therapy. The combined therapy can elevate the patients＇ overall survival rate, tumor ne- crosis rate and the rate of AFP reducing or returning to normal in serum and decrease local recurrence rate, PD rate compared with TACE alone.

基于整合药理学和转录组学的肝细胞癌和胆管癌共同差异miRNA调控网络构建及相关中药预测分析

目的:利用整合药理学和转录组学方法,构建肝细胞癌与胆管癌共同差异微RNA(miRNA)调控网络,并对关键靶点进行中药预测分析。方法:从GEO数据库获取肝细胞癌、胆管癌芯片数据集,借助在线分析工具GEO_(2)R分析出差异表达miRNA(DEMs)并对其取交集,得到共同DEMs,分别运用FunRich和miRNet软件预测上游转录因子及下游靶基因,并利用DAVID数据库对靶基因进行基因本体(GO)功能富集分析和京都基因与基因组百科全书(KEGG)通路富集分析。借助STRING数据库和Cytoscape 3.9.1软件筛选关键基因(hubGenes)并构建miRNA-hubGenes网络。运用UALCAN、Kaplan Meier-plotter和Coremin Medical数据库对关键基因进行差异表达、总体生存率及相关中药预测分析。结果:肝细胞癌筛选出14个DEMs,胆管癌筛选出104个DEMs, miR-199a-5p为两者共同DEMs,涉及28个上调转录因子,166个下游靶基因;富集分析结果显示,这些靶基因参与肿瘤细胞凋亡、增殖、间质转变和迁移等生物过程,主要通过癌症通路、FoxO信号通路、丝裂原激活的蛋白激酶信号通路以及磷脂酰肌醇3激酶-蛋白激酶B信号通路发挥作用;核心靶点关联中药性味偏微寒,主归肝经,关联最为密切的中药为丹参。结论:miR-199a-5p是肝细胞癌与胆管癌之间重要调控miRNA,丹参干预关键基因出现频次较多,与研究报道基本相符,可为后续肝胆癌机制研究和临床应用提供依据与参考。

The Comparative Study on Ultrastructure and Immunohistochemistry in AFP Negative and Positive Hepatocellular Carcinoma

Summary: To comparatively investigate ultrastructural characteristics and expressions of AFP (alpha-fetoprotein) and Tn (Thomsen-Friedenreich-related antigen) protein in AFP negative (AFP-) and AFP positive (AFP+) primary hepatocellular carcinoma. Fourty-three cases of AFP-and AFP+ hepatocellular carcinoma (HCC) tissues and five cases of normal liver tissues were divided into three groups: control group (normal liver tissue, n=5); AFP+ HCC group (the serum AFP level was higher than 10 ng/ml, n = 22); AFP-HCC group (the serum AFP level was lower than 10 ng/ml, n=21). The ultrastructural morphology was studied by transmission electron microscopy, the expressions of AFP and Tn protein were detected by immunohistochemistry and cell image analysis. 1. The immunohistochemical study showed that (1) the expression intensity and positive rate of Tn protein in AFP-HCC group were markedly higher than that in AFP+ HCC group (P<~0.01); (2) The expression intensity of AFP in AFP-HCC group was lower than that in AFP+ HCC group (P<0.01). 2. The transmission electron microscopy demonstrated that some AFP-HCC cells linked closely with each other, others dispersed loosely just as cultured cells, the remarkable morphologic features in AFP-HCC cells were simple organelles, but they were abundant in the free polyribosomes. In AFP+ HCC group, all the HCC cells linked closely together and were rich organelles in their cytoplasm, especially the rough endoplasmic reticula. In addition, mitochondria and Golgi complex were obviously observed. (1) The AFP and Tn protein had discrepancy distribution in AFP-and AFP+ HCC tissues, Tn protein may be one of the early diagnostic indicators in AFP-HCC; (2) The synthetic locations of the AFP and Tn protein were different in hepatocarcinoma cells by ultrastructural observation.

Relationship between survivin expression and recurrence,and prognosis in hepatocellular carcinoma

瞄准：在肝细胞学习 apoptosis 蛋白质 survivin 的禁止者的表示癌(HCC ) ，和它与在肝切除术以后的 clinicopathological 因素，房间增长，复发和预后的关联。方法：survivin 和 Ki-67 染色的 Immunohistochemical 被标准 streptavidin-peroxidase 技术在 HCC 的 55 个盒子的石蜡节上执行。结果：在 HCC 的 survivin 的积极的率是 52.7%(29/55 ) 。重要关联与门静脉血栓症和肝内 matastasistic 节点在 survivin 表示之间被发现(P 【 0.05 ) 。在 survivin 积极的 HCC 的周期性的率比在在肝切除术以后的 survivin 否定的 HCC，在有 survivin 积极的肿瘤的病人的 1 年、 3 年的幸存率在有 survivin 否定的肿瘤的病人是比那显著地低的显著地高(58.62 和 10.34% 对 76.92 和 30.77% ， P 【 0.05，木头等级测试) 。在 survivin 积极的 HCC 的增长索引(Ki-67 )(33.83%+/-18.90%) 在 survivin 否定的 HCC 比那显著地高(19.60%+/-19.35%)(P 【 0.05 ) 。结论：Survivin 可以由支持房间增长在 HCC 的前进起一个重要作用，并且可以断然在 HCC 与疾病复发和差的预后的高风险被相关。它的表示可以在肝切除术以后与 HCC 为病人用作一个预示的因素。

Effects of antiviral therapy on preventing liver tumorigenesis and hepatocellular carcinoma recurrence

Chronic hepatitis B virus(HBV)infection is the key driving force of liver disease progression,resulting in the development of hepatic dysfunction,cirrhosis and hepatocellular carcinoma(HCC).The primary aim of therapy is to suppress or eliminate HBV replication to reduce the activity of hepatitis,thus reducing the risk of,or slowing the progression of,liver disease.Nucleos(t)ide analogues(Nucs)may result in rapid suppression of HBV replication with normalization of serum transaminases and restore liver function,thus increasing survival in patients with hepatic decompensation.Long-term Nuc therapy may result in histological improvement or reversal of advanced fibrosis and reduction in disease progression,including the development of HCC.The long-term benefits of a finite course of interferon(IFN)-αtherapy also include a sustained and cumulative response,as well as hepatitis B surface antigen seroclearance and reduction in the development of cirrhosis and/or HCC.Pegylated IFN and newer Nucs may achieve better long-term outcomes because of improved efficacy and a low risk of drug resistance.However,treatment outcomes are still far from satisfactory.Understanding the effects of anti-HBV treatment against HCC incidence and recurrence after hepatectomy or liver transplantation is required for further improvement of outcome.

Capability of multidetector CT to diagnose hepatocellular carcinoma-associated arterioportal shunt

AIM: To investigate the capability of multidetector CT (MDCT) to diagnose HCC-associated arterioportal shunt (APS).METHODS: Two hundred and eighty-two patients with HCC received both thin-slice and enhancement MDCT scanning at early hepatic arterial phase, late hepatic arterial phase and portal venous phase, and digital subtract angiography (DSA) examination. Images were analyzed jointly by two experienced radiologists blinded to the opposite examination results, including the existence or not of APS, shunt locations, types and degrees of APS, with or without thrombosis. RESULTS: There were 56 APS associated with HCC, including 48 central, seven peripheral and one mixed, or 42 severe, seven moderate, seven mild APS. Fortyone severe, seven moderate and central APS were all revealed with MDCT and DSA. Seven mild and peripheral APS were all displayed with MDCT; only five of them displayed DSA, two faint shunt APS associated with massive HCC were missed. One mixed APS was demonstrated as severe combined with mild shunt with both MDCT and DSA.CONCLUSION: MDCT could diagnose not only DSA revealed APS, but also missed mild and peripheral APS with DSA due to faint shunt associated with massive HCC, is a simple, effective and noninvasive new technique for diagnosis of HCC-associated APS.

Metastasis of hepatocellular carcinoma to the small bowel manifested by intussusception

肝细胞癌(HCC ) 是造血地并且 lymphogenously 转移到远地点的一个高度侵略的肿瘤。经常的地点是肺，地区性的淋巴节点，骨头，和肾上腺。但是转移到胃肠(官方补给) 道稀罕、很普通地点胃。到小肠的转移是极其稀罕的。而且，引起摄取的小肠的变形 HCC 没被报导直到现在。这里，我们向摄取表明的小肠汇报 HCC 的转移的一个案例。

Intractable bleeding from solitary mandibular metastasis of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) metastasizes to themandible is infrequently seen. Solitary bony metastasis tothe mandible is rarer. The intractable bleeding caused byrupture of the metastatic HCC is challenging to clinicians.We present a case of a 74-year-old woman with HCCunder control without progression for 3 years. Left facialswelling and episodes of bleeding developed recently andbiopsy revealed a metastatic HCC. Computer tomographyshowed a large tumor in parapharyngeal space withevident mandibular ramus destruction. Bleeding occurredfrom the metastatic tumor but could not be controlledby electrocauterization, Surgicel?, tissue glue, andbone wax and angiographic embolization. Palliativeradiotherapy (2400 cGy in 6 fractions) was tried andthe intractable bleeding was successfully stopped afterthe radiotherapy. Because of the hypervascular andosteolytic nature of the solitary mandibular metastaticlesion, the bleeding was troublesome. Radiotherapyprovided successful control of intractable bleeding fromthe metastatic tumor.

A case of severe acalculous cholecystitis associated with sorafenib treatment for advanced hepatocellular carcinoma

Sorafenib,a multikinase inhibitor,is the first and only drug,which improves significantly the overall survival in patients with advanced hepatocellular carcinoma(HCC).However,many patients experience diverse side effects,some of them severe and unexpected.To date,acute acalculous cholecystitis has not been documented in association with a HCC patient treated with sorafenib.Here,we report the case of a 43-yearold woman with hepatitis C virus-related advanced HCC.She received sorafenib,and later complained ofa sudden onset of severe right hypocondrial pain with rebound tenderness and muscle defense.Laboratory examination showed mild elevation of transaminases,biliary enzymes,bilirubin,inflammation markers,and a marked peripheral eosinophilia.Abdominal computed tomography(CT) revealed a swollen gallbladder with exudate associated with severe inflammation without stones or debris.Consequently,sorafenib treatment was stopped immediately,and steroid-pulse therapy was performed.Steroid therapy drastically improved all clinical manifestations along with normalization of CT findings,eosinophilia,and liver functions.In summary,we herein report a rare case of acute severe acalculous cholecystitis associated with sorafenib in the patient with advanced HCC.

真核翻译起始因子3遗传变异与HBV相关肝细胞癌发病风险的相关性

目的 探讨真核翻译起始因子3(eukaryotic translation initiation factor 3,eIF3)遗传变异与乙型肝炎病毒相关肝细胞癌(HBV-HCC)发病风险的关系。方法 本研究采用两阶段病例对照研究的方法,发现阶段以广西的966例HCC病例和1 003例乙型肝炎病毒表面抗原(hepatitis B surface antigen,HBsAg)阳性对照为研究对象,筛选出与HCC发病风险有关联的单核苷酸多态性(single nucleotide polymorphisms,SNP)位点,验证阶段采用上海的480例HCC病例和484例HBsAg阳性对照人群对发现阶段的阳性位点进行验证。通过单因素和多因素logistic回归分析eIF3遗传变异位点与HBV-HCC发病风险的相关性。结果本研究发现EIF3G 3′-UTR区2个具有潜在功能的SNPs(rs7401 A>G和rs23057952 A>G)与HBV-HCC的发病风险相关。其中与A等位基因携带者相比,rs7401 G等位基因携带者的HBV-HCC发病风险增加(OR=1.18,95%CI:1.02~1.38,P=0.028);而与A等位基因相比,rs2305795 G等位基因可降低HBV-HCC发病风险(OR=0.74,95%CI:0.64~0.86,P<0.001)。联合分析结果表明,携带联合风险基因型(rs7401 AG/GG基因型和rs2305795 AA基因型)的数量与HBV-HCC发病风险上升呈剂量-反应关系(Ptrend<0.001)。表达数量性状位点(expression quantitative trait loci,eQTL)分析表明,rs7401 G等位基因和rs2305795 A等位基因均与全血中EIF3G mRNA表达水平升高显著相关,并且EIF3G mRNA的表达水平在HCC癌组织中明显高于正常组织。结论EIF3G rs7401 G等位基因和EIF3G rs2305795 A等位基因均增加HBV-HCC的发病风险。

TACE术联合TKI及PD-1单抗综合治疗进展期肝癌的临床疗效及安全性分析

目的探讨肝动脉化疗栓塞(TACE)联合抗血管生成药(TKI)及程序性死亡受体1(PD-1)单抗综合治疗进展期肝癌的临床疗效及安全性。方法纳入2019年9月至2021年9月西南医科大学附属医院收治的108例进展期肝癌患者,按治疗方式差异分为TACE+TKI组(n=60)及TACE+TKI+PD-1单抗组(n=48)。回顾性收集两组患者的临床资料,用倾向评分匹配(PSM)控制基线特征,分析PSM后两组患者临床疗效、生存情况,并对两组不良反应发生情况作统计分析。结果PSM后两组患者临床疗效比较,差异无统计学意义(P>0.05)。截止至2023年3月,TACE+TKI+PD-1单抗组PSM后中位无进展生存期(PFS)、总生存期(OS)分别为9.6个月、17.0个月,长于TACE+TKI组(6.4个月、10.8个月),差异均有统计学意义(P<0.05)。两组PSM后Ⅰ+Ⅱ级、Ⅲ+Ⅳ级不良反应发生率比较,差异均无统计学意义(P>0.05)。结论进展期肝癌患者应用TACE联合TKI或是TACE联合TKI及PD-1单抗均可获得较佳临床疗效,但后者可延长患者生存期,且不提高不良反应发生率。

血清HOXC9和AFP在早期肝癌患者中的水平及临床意义

目的分析血清同源盒基因9(HOXC9)与甲胎蛋白(AFP)联合检测在早期肝细胞癌(HCC)诊断中的价值。方法选取2020年1月至2021年12月在连云港市东方医院就诊的120例肝病患者作为研究对象,其中包括58例早期HCC患者(早期HCC组)和62例良性肝病患者(良性肝病组),另选取同期在该院体检的60例健康体检者作为对照组。分别采用酶联免疫吸附试验(ELISA)和化学发光法检测血清HOXC9、AFP水平;采用受试者工作特征(ROC)曲线分析血清HOXC9、AFP单独及联合检测对早期HCC的诊断效能;采用Spearman相关分析血清HOXC9和AFP的相关性。结果早期HCC组、良性肝病组和对照组血清HOXC9、AFP水平比较,差异均有统计学意义(P<0.05);早期HCC组和良性肝病组血清HOXC9、AFP水平显著高于对照组,差异均有统计学意义(P<0.05)。血清HOXC9单独检测诊断早期HCC的曲线下面积(AUC)为0.821(95%CI:0.722~0.878)、灵敏度为91.8%、特异度为72.6%;血清AFP单独检测诊断早期HCC的AUC为0.611(95%CI:0.538~0.794)、灵敏度为77.8%、特异度为94.1%。血清HOXC9和AFP联合检测诊断早期HCC的AUC为0.956(95%CI:0.840~0.984),明显高于血清HOXC9和AFP单独检测(Z=0.871、0.511,P<0.05)。Spearman相关性分析结果显示,血清HOXC9水平与AFP水平无相关性(r=0.015,P=0.129)。结论血清HOXC9检测对早期HCC患者有一定的诊断价值,与AFP联合检测可显著提高对早期HCC的诊断效能。

鳖甲煎丸对肝细胞癌中Wnt/β-catenin信号通路及抑制基因DKK-1、FrpHe表达的影响

目的通过研究鳖甲煎丸对肝细胞癌中Wnt信号通路及抑制基因DKK-1、FrpHe表达的影响,探讨其抗肝细胞癌转移侵袭的作用机制与Wnt/β-catenin信号通路的关系。方法 24只Wistar大鼠随机分为3组(8只/组),分别以临床剂量的20倍、10倍的鳖甲煎丸和生理盐水灌胃3 d,3 d后采血,离心,获取血清。分别将3组血清加入DMEM培养液中培养肝癌细胞HepG2,48 h后采用流式细胞术检测细胞中的β-catenin蛋白含量,qRT-PCR法检测DKK-1、FrpHe基因的表达情况,以进一步阐明药物的作用机制与Wnt/β-catenin信号通路的关系。结果流式细胞术结果:高剂量组和中剂量组含药血清均可显著降低细胞中β-catenin蛋白表达,且该作用与药物浓度有关。RT-PCR结果:高剂量组和中剂量组含药血清均可显著下调DKK-1基因的表达,且该作用与药物浓度有关。而高剂量组和中剂量组含药血清对FrpHe基因的表达影响不明显。结论鳖甲煎丸能显著抑制肝细胞癌的生长、粘附和转移,且这种抑制作用与显著降低肝癌细胞中β-catenin蛋白表达、显著下调DKK-1基因的表达,从而阻断Wnt/β-catenin信号通路有关。

原发性肝癌伴动静脉瘘介入栓塞治疗62例回顾性分析

目的：回顾性分析原发性肝癌合并动静脉瘘（AVS）的介入栓塞治疗疗效。分析影响其疗效的相关因素。方法回顾性分析62例原发性肝癌合并动静脉瘘的介入栓塞治疗的临床资料，根据血管造影明确AVS的类型、程度后，按不同方式进行堵瘘及肿瘤化疗栓塞治疗。再次造影评价瘘口封堵的疗效，单因素和多因素分析影响栓塞疗效的相关因素。结果62例患者中肝动脉-门静脉瘘44例，肝动-静脉瘘11例，肝动脉-门脉瘘合并肝动-静脉瘘4例，肝动脉-肺动脉瘘3例。53例患者1-2个月后DSA复查发现动静脉瘘消失18例，分流量明显减轻19例，稳定9例，进展7例。单因素分析发现栓塞材料和门静脉癌栓可影响肝动脉-门脉瘘介入栓塞的疗效，而多因素回归分析显示门静脉癌栓是独立危险因素。采用PVA颗粒和碘油无水乙醇混悬液栓塞疗效优于明胶海绵。结论肝癌合并肝动-静脉瘘的介入栓塞治疗应根据动静脉瘘的类型、程度等采用个体化治疗策略，栓塞材料亦在一定程度上影响瘘的再通。

碘[^(131)I]-美妥昔单抗注射液的人体药代动力学研究

研究碘[131I]-美妥昔单抗注射液的人体药代动力学特征,为临床给药方案及临床应用提供依据。将按纳入标准、排除标准和剔除标准选择的患原发性肝细胞肝癌受试者24例平均分为低、中、高剂量组,各组每位受试者经插管注入相应的注射液,分别在不同时刻采集静脉血及收集尿液,测定样品的放射性计数率(min-1);采用纸层析确定各血样血清中药物的比例,依此校正各血样中药物的放射性计数率;用DASver1.0(Drug And Statistics for Windows)药代动力学程序拟合、计算血液药代动力学参数;鉴定尿液中放射性物质的组成,计算各时间段尿液放射性占注入剂量的百分率(%ID),以分析注射液在尿液的清除动力学特点。研究表明:该注射液血液药代动力学符合动力学二室模型,其在人体内分解代谢产物主要以游离131I的形式通过肾脏排泄,注入后120h内排出尿液的放射性占注入剂量的47.70%~51.16%。因此,该注射液的药代动力学特征满足临床要求,推荐临床的给药剂量为每kg人体27.75MBq注射液。

TACE联合分子靶向药索拉菲尼治疗晚期肝癌远期疗效观察

目的评价经肝动脉灌注化疗栓塞术(TACE)联合分子靶向药物甲磺酸索拉菲尼治疗晚期肝细胞肝癌(HCC)的临床疗效和不良反应。方法 2007年6月至2009年5月,江苏省肿瘤医院介入科收治的30例晚期HCC患者,采用经TACE或单纯动脉灌注化疗,术中用药为氟脲苷1.0 g,羟基喜树碱20 mg,吡柔比星30 mg,碘油栓塞肿瘤供血动脉。口服甲磺酸索拉菲尼,起始剂量400 mg,每日2次,治疗过程中根据不良反应情况调整用量。每6～8周复查1次,评价肝功能,治疗效果(CT复查、术中DSA等)和不良反应。用SPSS13.0软件统计计算中位生存时间,平均生存时间和无疾病进展时间。结果至2009年12月,30例患者均达到临床评价要求,无中途停药。口服索拉菲尼相关不良反应发生率83.3%。主要不良反应为手足皮肤反应、腹泻和高血压。无疾病进展期内DSA术中造影可见肿瘤血管较服药前稀疏,纤细。经统计学分析,中位生存期38周,平均生存期41周,无疾病进展时间18周。结论晚期肝癌,经TACE术联合索拉菲尼口服治疗无严重不良反应发生。

动脉灌注p53基因治疗晚期肝癌的初步临床应用

目的初步观察动脉灌注p53基因治疗晚期肝癌的疗效。方法晚期肝癌30例,治疗组14例,对照组16例。根据造影表现决定灌注药物的靶动脉,治疗组在靶动脉注入p53基因,每次用10^(12)VP,加羟基喜树碱20 mg,每周1次,连用3周为1疗程,14例患者分别接受1～4疗程的治疗。对照组给予羟基喜树碱20 mg肝动脉灌注。结果治疗组生存期最小14 d,最长405 d,平均238．1 d。对照组生存期最小18 d,最长167 d,平均80．7 d。两者相比较,P＜0．05,有显著差异。结论p53基因治疗晚期肝癌有效。

肝癌放疗前后血浆VEGF表达的临床意义

目的观察肝癌患者放疗前后血浆血管内皮生长因子(VEGF)水平与疗效之间的关系。方法用ELISA法检测42例非手术肝癌患者放疗前1d、放疗开始后7d及1个月时血浆VEGF含量。按近期疗效分为有效组与无效组,按治疗前VEGF含量分为高水平组与低水平组,分析近期疗效、无疾病进展时间及1年生存率与VEGF之间的关系。结果近期有效率(CR+PR)为71.4%,无效率(NC+PD)为28.6%。有效组放疗前后血浆VEGF水平均低于无效组,差异有统计学意义(P=0.000)。治疗前高、低水平组无疾病进展时间分别为3.1、6.9个月,差异有统计学意义(P=0.000),1年生存率分别为42.9%、76.2%,差异有统计学意义(P=0.000)。结论肝癌患者血浆VEGF水平可作为放疗效果预测指标。