131Ⅰ-美妥西单抗肝动脉灌注结合化疗栓塞治疗晚期原发性肝癌的疗效观察

目的 比较131Ⅰ-美妥西单抗动脉灌注结合化疗栓塞(LTACE)与常规肝动脉化疗栓塞(TACE)治疗晚期原发性肝癌的近期效果.方法 晚期肝癌患者72例,根据患者的要求分别采用LTACE治疗(LTACE组,29例)和常规TACE治疗(TACE组,43例).LTACE组经肿瘤供血动脉缓慢注入27.75 MBq/kg 131Ⅰ-美妥西单抗后间歇30 min,再以超液态碘油30 ml与表阿霉素40 mg混悬液栓塞直至血管铸型;TACE组经肿瘤供血动脉注入超液态碘油30 ml与表阿霉素40 mg混悬液栓塞直至血管铸型.治疗后,两组均行保肝和对症处理.疗效观察随访指标包括临床症状、体征缓解情况,肝、肾功能,外周血常规及CT和核素发射计算机辅助断层显像(ECT)的检查结果.计量资料行t检验;计数资料采用卡方检验和Fisher精确检验,两组生存率的比较采用Kaplan-Meier生存分析和log-rank检验.结果 治疗后,两组患者血浆白蛋白、丙氨酸转氨酶、总胆红素、白细胞、血小板及肌酐水平差异无统计学意义(治疗7 d后各指标比较的t值分别为0.250、0.907、0.629、0.005、0.250、0.453,14 d时分别为0.978、1.250、1.942、0.733、0.315、1.243;P值均>0.05).ECT扫描显示LTACE组肿瘤组织对131Ⅰ-美妥西单抗摄取良好率为55.17%(16/29).肿瘤大小两组治疗后病灶均有缩小,且组内差异有统计学意义(t=7.207,8.006,P<0.01),但治疗前LTACE及TACE组肿瘤大小(cm2)经对数转换后分别为(1.68±0.32)、(1.74±0.31);治疗后分别为(1.52±0.38)、(1.61±0.36),差异均无统计学意义(t=0.786,0.891,P值均>0.05).两组6个月的累计存活率分别为52%、76%,差异无统计学意义(X2=3.080,P>0.05).结论 131Ⅰ-美妥西单抗动脉灌注结合化疗栓塞治疗晚期原发性肝癌的短期结果与常规肝动脉化疗栓塞相比无明显差异,但确切疗效还有待大样本、多中心随机对照研究证实.

Therapeutic effect of transarterial licartin infusion in combination with transcatheter arterial chemoembolization for advanced hepatocellniar carcinoma

Objective To investigate the short term effect of licartin transarterial infusion in combination with chemoembolization (LTACE) and compare its effect with conventional transcatheter arterial chemoembolization (TACE) for advanced hepatocellular carcinoma (HCC).Methods Seventy-two cases of advanced HCC were included in this analysis.There were 50 males and 22 females with the average age of (58±12) yrs (range 34-86 yrs).Twenty-nine patients received LTACE treatment while the other forty three patients received conventional TACE treatment.Before intervention,there was no variation (P>0.05) in gender (X2 =0.202),Child-Pugh grading for hepatic function (X2=2.428),as well as in white blood cell count (t=1.101)and platelet count (t =0.080) between the two groups except for age and portal vein thrombosis.For LTACE group,30 minutes after the infusion of licartin (27.75 MBq/kg) into proper hepatic artery,an emulsion of 40 rag pharmorubicin and 30 ml uhrafluid lipidol was infused until hemostasis within target artery.For TACE group,only an emulsion of 40 nag pharmorubicin and 30ml uhrafluid lipidol was infused until hemostasis within target artery.Following these interventions,the two groups were given the same treatment to stabilize hepatic function and relief embolization-relating symptoms; Patients' follow-up included clinical symptoms and signs,hepatic and renal function,peripheral blood test,CT and radionuclide study(ECT).All data were analyzed with SPSS 11.5.Measurement data were expressed with mean and processed by t test; numeration data were processed by Chi square test and Fisher precise test; Kaplan-Meier analysis and log-rank test were applied for comparing the survival rate of the two groups.P <0.05 means the exist of a statistic variation.Results After treatment,there was no variation of Albumin,GPT,serum bilirubin,white blood cell,platelet and serum creatinine level between the two groups t=0.250,0.907,0.629,0.005,0.250,0.453 (7 days) and 0.978,1.250,1.942,0.733,0.315,1.243 (14 days); P >0.05].ECT imaging demonstrated a 55.17% (16/29) uptake ratio of licartin within tumor areas by the time of 7-days follow-up study.The lesions in both LTACE and TACE groups exhibited a decrease in their size and statistically significant difference was demonstrated before and after treatment in either group( t=7.207,8.006,P <0.01).But between the two groups,the tumor size reduction showed no statistical difference,the tumor size in LTACE and TACE groups were( 1.68±0.32),(1.74±0.31)respectively (t =0.786,P>0.05)before treatment and(1.52±0.38),(1.61±0.36) respectively(t=0.891,P>0.05) after treatment.There was no variation between the two groups comparing the 6 months cumulative survival rate(LTACE 52%,TACE 76%,log-rank test,X2=3.080,P >0.05).Conclusion There was no statistically significant differences between LTACE and TACE groups concerning the short term effect and adverse reaction for treatment of advanced HCC.The long term outcomes should be established on the basis of a large-sample,multiconter,randomized trail.