Embosphere微球在肝癌TACE治療中的臨床療效分析
發(fā)布時間：2019-01-04 11:27
【摘要】：目的 比較Embospher微球聯(lián)合碘化油化療乳劑與常規(guī)碘化油乳劑在肝癌TACE治療中的臨床療效。方法 收集2015年10月至2016年10月,因原發(fā)性肝癌(PCL)行經(jīng)導管動脈化療栓塞術(TACE)的患者的臨床資料,每例患者從首次行TACE開始,平均隨訪6個月。根據(jù)TACE術中是否使用Embospher微球,分為微球組(EM-TACE)和常規(guī)組(c-TACE)。根據(jù)入組標準,使兩組病例在年齡、性別、HBs Ag、巴塞羅那臨床分期(BCLC)、腫瘤大小、數(shù)目、血供及邊界情況等方面均衡一致。比較兩組患者多次TACE治療后不良反應情況、肝功能和甲胎蛋白(AFP)的變化,并根據(jù)m RECIST標準評價首次及末次TACE術后4-6周肝癌的局部控制情況。結果 符合入組標準的患者共85例,EM-TACE組40例,c-TACE組45例,隨訪期間所有患者接受2-4次TACE治療,首次TACE治療時,79例的患者實現(xiàn)超選擇性肝動脈化療栓塞,技術成功率為93%(79/85);多次治療過程中,術后無一例發(fā)生肝功能衰竭、肝膿腫、急性膽囊炎等嚴重并發(fā)癥。隨訪期間,EM-TACE組累計接受132次TACE治療,人均3.3次,術后累計發(fā)熱62例次,腹痛48例次,惡心或嘔吐37例次;c-TACE組,分別為151次,3.4次,71例次、52例次、43例次,兩組比較無統(tǒng)計學差異。首次TACE術后1-7天復查肝功能,丙氨酸氨基轉(zhuǎn)移酶(ALT)、天門冬氨酸氨基轉(zhuǎn)移酶(AST)、白蛋白(ALB)、血清總膽紅素(TBIL)、結合膽紅素(CB)有不同程度升高或降低,但兩組比較無統(tǒng)計學差異;末次TACE術后4-6周肝功能各主要指標與術前一周比較無統(tǒng)計學差異。首次TACE術前與末次TACE術后4-6周,兩組AFP均明顯下降,且EM-TACE組下降程度較明顯。首次TACE術后4-6周,復查上腹部增強CT或MRI,根據(jù)m RECIST標準評價腫瘤控制情況,EM-TACE組,CR、PR、SD、PD的患者計數(shù)分別為2例、20例、16例、2例,有效率(CR+PR)55.0%,獲益率(CR+PR+SD)95.0%;c-TACE組,分別為0例、15例、26例、4例,有效率為33.33%,獲益率91.11%,兩組比較有統(tǒng)計學差異(P0.05)。末次TACE術后1個月,EM-TACE組,CR、PR、SD、PD分別為1例、18例、17例、4例,有效率47.5%,獲益率90%;c-TACE組,分別為0例、12例、25例、8例,26.67%,82.22%,兩組比較有統(tǒng)計學差異(P0.05)。結論 Embospher微球聯(lián)合碘油化療乳劑治療中期肝癌,患者耐受性可,安全可行,與常規(guī)治療無明顯差異;腫瘤局部控制率優(yōu)于常規(guī)碘化油化療栓塞。TACE操作時,采用微導管超選擇性技術,靶向性栓塞效果更好,而且也能減輕正常肝組織損傷。肝癌預后與BCLC分期、腫瘤大小、數(shù)目、Child分級等因素有關,此外患者的規(guī)律復查及隨訪也是影響預后的重要因素。
[Abstract]:Objective to compare the clinical efficacy of Embospher microspheres combined with iodized oil emulsion and routine iodized oil emulsion in the treatment of liver cancer with TACE. Methods from October 2015 to October 2016, the clinical data of patients with (TACE) undergoing transcatheter arterial chemoembolization (TACE) for primary liver cancer (PCL) were collected. Each patient was followed up for an average of 6 months from the first TACE. According to whether Embospher microspheres were used in TACE, they were divided into two groups: EM-TACE and c-TACE. According to the admission criteria, the size, number, blood supply and boundary conditions of (BCLC), tumors in, HBs Ag, Barcelona clinical stage were balanced and consistent between the two groups. The adverse reactions, liver function and alpha-fetoprotein (AFP) were compared between the two groups after repeated TACE treatment, and the local control of liver cancer was evaluated according to m RECIST criteria at 4-6 weeks after the first and last TACE. Results there were 85 patients who met the standard of admission, 40 patients in EM-TACE group and 45 patients in c-TACE group. During the follow-up period, all patients received 2-4 times of TACE therapy. At the first time of TACE treatment, 79 patients underwent superselective hepatic arterial chemoembolization. The technical success rate was 93% (79 / 85). No severe complications such as liver failure, liver abscess and acute cholecystitis occurred during multiple treatment. During the follow-up period, the EM-TACE group received 132times of TACE treatment, 3.3 times per capita, 62 times of postoperative fever, 48 cases of abdominal pain, 37 times of nausea or vomiting. In c-TACE group, there were 151, 3.4, 71, 52, 43 times, respectively. There was no statistical difference between the two groups. Liver function was reexamined 1-7 days after the first TACE. Serum total bilirubin (TBIL), combined with bilirubin (CB) increased or decreased in serum of (ALT), aspartate aminotransferase (AST), albumin (ALB),. But there was no statistical difference between the two groups. There was no significant difference in liver function between 4-6 weeks after last TACE and 1 week before operation. Before the first TACE and 4 to 6 weeks after the last TACE, the AFP decreased significantly in both groups, and the degree of decrease was obvious in the EM-TACE group. Four to six weeks after the first TACE operation, the tumor control was evaluated by CT or MRI, on epigastric enhancement according to m RECIST standard. The number of patients in EM-TACE group and CR,PR,SD,PD group were 2 cases, 20 cases, 16 cases, 2 cases, respectively. The effective rate of (CR PR) was 55.0 and the rate of benefit was (CR PR SD) 95.0; In c-TACE group, there were 0 cases, 15 cases, 26 cases, 4 cases, the effective rate was 33.33, and the benefit rate was 91.11.The difference between the two groups was statistically significant (P0.05). One month after the last TACE, CR,PR,SD,PD in EM-TACE group was 1 case, 18 cases, 17 cases and 4 cases respectively. The effective rate was 47.5%, and the rate of benefit was 90%. In c-TACE group, there were 0 cases, 12 cases, 25 cases, 8 cases, 26.67 and 82.22, respectively. There was statistical difference between the two groups (P0.05). Conclusion Embospher microspheres combined with lipiodol emulsion in the treatment of middle stage liver cancer patients have good tolerance, safety and feasibility, and there is no significant difference from routine treatment. The local control rate of tumor was better than that of conventional lipiodol chemoembolization. When TACE was operated, the effect of targeting embolization was better by using microcatheter super-selective technique, and the injury of normal liver tissue was also alleviated. The prognosis of HCC is related to the BCLC stage, tumor size, tumor number, Child grade and so on. In addition, regular reexamination and follow-up of patients are also important factors affecting prognosis.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.7
本文編號：2400226
[Abstract]:Objective to compare the clinical efficacy of Embospher microspheres combined with iodized oil emulsion and routine iodized oil emulsion in the treatment of liver cancer with TACE. Methods from October 2015 to October 2016, the clinical data of patients with (TACE) undergoing transcatheter arterial chemoembolization (TACE) for primary liver cancer (PCL) were collected. Each patient was followed up for an average of 6 months from the first TACE. According to whether Embospher microspheres were used in TACE, they were divided into two groups: EM-TACE and c-TACE. According to the admission criteria, the size, number, blood supply and boundary conditions of (BCLC), tumors in, HBs Ag, Barcelona clinical stage were balanced and consistent between the two groups. The adverse reactions, liver function and alpha-fetoprotein (AFP) were compared between the two groups after repeated TACE treatment, and the local control of liver cancer was evaluated according to m RECIST criteria at 4-6 weeks after the first and last TACE. Results there were 85 patients who met the standard of admission, 40 patients in EM-TACE group and 45 patients in c-TACE group. During the follow-up period, all patients received 2-4 times of TACE therapy. At the first time of TACE treatment, 79 patients underwent superselective hepatic arterial chemoembolization. The technical success rate was 93% (79 / 85). No severe complications such as liver failure, liver abscess and acute cholecystitis occurred during multiple treatment. During the follow-up period, the EM-TACE group received 132times of TACE treatment, 3.3 times per capita, 62 times of postoperative fever, 48 cases of abdominal pain, 37 times of nausea or vomiting. In c-TACE group, there were 151, 3.4, 71, 52, 43 times, respectively. There was no statistical difference between the two groups. Liver function was reexamined 1-7 days after the first TACE. Serum total bilirubin (TBIL), combined with bilirubin (CB) increased or decreased in serum of (ALT), aspartate aminotransferase (AST), albumin (ALB),. But there was no statistical difference between the two groups. There was no significant difference in liver function between 4-6 weeks after last TACE and 1 week before operation. Before the first TACE and 4 to 6 weeks after the last TACE, the AFP decreased significantly in both groups, and the degree of decrease was obvious in the EM-TACE group. Four to six weeks after the first TACE operation, the tumor control was evaluated by CT or MRI, on epigastric enhancement according to m RECIST standard. The number of patients in EM-TACE group and CR,PR,SD,PD group were 2 cases, 20 cases, 16 cases, 2 cases, respectively. The effective rate of (CR PR) was 55.0 and the rate of benefit was (CR PR SD) 95.0; In c-TACE group, there were 0 cases, 15 cases, 26 cases, 4 cases, the effective rate was 33.33, and the benefit rate was 91.11.The difference between the two groups was statistically significant (P0.05). One month after the last TACE, CR,PR,SD,PD in EM-TACE group was 1 case, 18 cases, 17 cases and 4 cases respectively. The effective rate was 47.5%, and the rate of benefit was 90%. In c-TACE group, there were 0 cases, 12 cases, 25 cases, 8 cases, 26.67 and 82.22, respectively. There was statistical difference between the two groups (P0.05). Conclusion Embospher microspheres combined with lipiodol emulsion in the treatment of middle stage liver cancer patients have good tolerance, safety and feasibility, and there is no significant difference from routine treatment. The local control rate of tumor was better than that of conventional lipiodol chemoembolization. When TACE was operated, the effect of targeting embolization was better by using microcatheter super-selective technique, and the injury of normal liver tissue was also alleviated. The prognosis of HCC is related to the BCLC stage, tumor size, tumor number, Child grade and so on. In addition, regular reexamination and follow-up of patients are also important factors affecting prognosis.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.7
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