原发性肝癌根治性切除术后不同时间TACE对血清肿瘤标志物及复发风险的影响

摘要/Abstract

摘要： 目的观察原发性肝癌根治术后不同时间肝动脉介入化疗栓塞术(TACE)对血清肿瘤标志物和复发风险的影响。方法选取2016年3月—2019年10月亳州市中医院接受根治性切除术治疗的65例原发性肝癌患者,使用随机数字表法分为观察组(33例)和对照组(32例)。两组均在根治性切除术后进行TACE治疗,其中观察组术后4周进行TACE治疗,对照组术后8～12周进行TACE治疗,两组第1次TACE治疗后间隔4周后接受第2次治疗。比较两组术后并发症及随访3年肝内复发率。结果治疗前,两组癌胚抗原(CEA)分别为(26.63±5.19)ng/mL、(25.48±4.03)ng/mL,两组甲胎蛋白(AFP)分别为(84.39±8.61)μg/L、(85.52±9.36)μg/L,两组糖类抗原199(CA199)分别为(81.06±7.93)U/L、(80.54±6.68)U/L,两组CEA、AFP、CA199无明显差异(P>0.05);治疗后,两组CEA分别为(4.13±0.72)ng/mL、(6.18±0.95)ng/mL,两组AFP分别为(16.28±3.65)μg/L、(24.97±5.14)μg/L,两组CA199分别为(23.74±4.16)U/L、(28.09±5.52)U/L,观察组均较低(P<0.05)。两组术后1年复发率分别为15.15%、37.50%,术后2年复发率分别为27.27%、53.13%,术后3年复发率51.52%、71.88%,观察组术后1年、2年的复发率均较低(P<0.05)。观察组出现骨髓抑制2例(6.06%)、肝功能损害15例(45.45%)、发热9例(27.27%)、上腹部疼痛12例(36.36%)、消化道症状7例(21.21%),对照组骨髓抑制3例(9.38%)、肝功能损害13例(40.63%)、发热6例(18.75%)、上腹部疼痛10例(31.25%)、消化道症状8例(25.00%),各项并发症发生率均无明显差异(P>0.05)。结论肝癌根治性切除术后4周行TACE术治疗安全性较高,原发性肝癌患者接受根治性手术后4周行TACE治疗,有利于下调CEA、AFP、CA199等血清肿瘤标志物水平,降低术后2年内复发率,对术后2年后复发率无明显影响。

关键词: 原发性肝癌, 根治性切除术, 肝动脉介入化疗栓塞术, 肿瘤标志物, 肝内复发

Abstract: Objective To observe the effect of transcatheter arterial chemoembolization (TACE) on serum tumor markers and recurrence risk after radical resection of primary hepatocellular carcinoma (HCC). Methods A total of 65 patients with HCC who underwent radical resection in Bozhou Hospital of Traditional Chinese Medicine from March 2016 to October 2019 were divided into observation group (33 cases) and control group (32 cases) by random number table method. Both groups received TACE treatment after radical resection, the observation group received TACE treatment 4 weeks after surgery, the control group received TACE treatment 8~12 weeks after surgery. Both groups received the second treatment 4 weeks after the first TACE treatment. Serum carcinoembryonic antigen (CEA), alpha fetoprotein (AFP), carbohydrate antigen 199 (CA199) were detected. Postoperative complications and intrahepatic recurrence rates were compared between the two groups. Results At baseline, CEA was (26.63±5.19) ng/mL and (25.48±4.03) ng/mL, AFP was (84.39±8.61) μg/L and (85.52±9.36) μg/L, CA199 was (81.06±7.93) U/L and (80.54±6.68) U/L, respectively. There was no significant difference in CEA, AFP and CA199 between the two groups (P>0.05). After treatment, CEA was (4.13±0.72) ng/mL, (6.18±0.95) ng/mL, AFP was (16.28±3.65) μg/L, (24.97±5.14) μg/L, respectively. The CA199 levels of the two groups were (23.74±4.16) U/L and (28.09±5.52) U/L, respectively, which were lower in the observation group (P<0.05). The 1-year recurrence rates of the two groups were 15.15% and 37.50%, the 2-year recurrence rates were 27.27% and 53.13%, and the 3-year recurrence rates were 51.52% and 71.88%, respectively. The 1-year and 2-year recurrence rates of the observation group were lower (P<0.05). In the observation group, there were 2 cases (6.06%) with bone marrow suppression, 15 cases (45.45%) with liver function impairment, 9 cases (27.27%) with fever, 12 cases (36.36%) with upper abdominal pain, and 7 cases (21.21%) with digestive tract symptoms. In the control group, there were 3 cases with bone marrow suppression (9.38%), 13 cases with liver function impairment (40.63%), 6 cases with fever (18.75%), 10 cases with upper abdominal pain (31.25%) and 8 cases with digestive tract symptoms (25.00%). There were no significant differences in the incidence of complications (P>0.05). Conclusion TACE 4 weeks after radical resection of HCC is safe, and is beneficial to down-regulate the levels of serum tumor markers such as CEA, AFP and CA199. It reduces the recurrence rate within 2 years after surgery, with no significant effect on the recurrence rate after 2 years.

Key words: Primary hepatocellular carcinoma, Radical resection, Hepatic artery interventional chemoembolization, Tumor markers, Intrahepatic recurrence

李刚, 曹志群, 牛帅. 原发性肝癌根治性切除术后不同时间TACE对血清肿瘤标志物及复发风险的影响[J]. 肝脏, 2023, 28(7): 781-784.

LI Gang, CAO Zhi-qun, NIU Shuai. Effect of TACE on serum tumor markers and recurrence risk after radical hepatocellular carcinoma resection at different time[J]. Chinese Hepatolgy, 2023, 28(7): 781-784.

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