经导管肝动脉化疗栓塞联合大分割三维适形放疗治疗不可切除原发性肝癌的疗效评价

肝脏 ›› 2023, Vol. 28 ›› Issue (9): 1079-1083.

经导管肝动脉化疗栓塞联合大分割三维适形放疗治疗不可切除原发性肝癌的疗效评价

栗明, 蒋著椿, 石永刚, 董世亮, 何自怀, 潘梅芳

542800 广西贺州市人民医院肿瘤科一病区(栗明,蒋著椿,潘梅芳),放疗技术组(何自怀);450052 河南郑州大学第一附属医院放疗科三病区(石永刚),放射治疗部(董世亮)

收稿日期:2023-06-05 出版日期:2023-09-30 发布日期:2023-10-24
通讯作者: 蒋著椿,Email:jiangzhuchun@163.com
基金资助:
广西壮族自治区卫生健康委员会自筹经费科研项目(Z20200946)

Evaluation of the therapeutic effect of transcatheter hepatic artery chemoembolization combined with large segment three-dimensional conformal radiotherapy on unresectable primary liver cancer

LI Ming¹, JIANG Zhu-chun¹, SHI Yong-gang², DONG Shi-liang³, HE Zi-huai⁴, PAN Mei-fang¹

1. First Ward, Oncology Department, Hezhou Municipal People's Hospital, Henan 542800, China;
2. Third Ward of Radiotherapy Department, the First Affiliated Hospital of Zhengzhou University, Henan 450052, China;
3. Department of Radiotherapy, The First Affiliated Hospital of Zhengzhou University, Henan 450052, China;
4. Radiotherapy Technology Group, Hezhou Municipal People's Hospital, Henan 542800, China

Received:2023-06-05 Online:2023-09-30 Published:2023-10-24
Contact: JIANG Zhu-chun, Email:jiangzhuchun@163.com

摘要/Abstract

摘要： 目的探讨经导管肝动脉化疗栓塞(TACE)联合大分割三维适形放疗治疗不可切除原发性肝癌的临床疗效。方法回顾性选取贺州市人民医院2018年1月—2021年1月收治的不可切除原发性肝癌患者作为研究对象。根据治疗方式的不同分组:30例采用TACE治疗(介入组),32例采用TACE联合大分割三维适形放疗(联合组)。对比两组的近期疗效、中远期疗效、不良反应情况及治疗前后的血清趋化因子9(CXCL9)、热休克蛋白90(HSP90)水平变化。结果联合组的总有效率与介入组接近(84.38%比76.67%, P>0.05)。两组治疗后的血清CXCL9、HSP90、β-catenin较治疗前明显降低,联合组治疗后的血清CXCL9、HSP90、β-catenin水平分别为(658.82±27.96)pg/mL、(0.04±0.01)ng/mL和(264.52±51.46)pg/L,均显著低于介入组的(760.82±30.64)pg/mL、(0.05±0.02)ng/mL和(390.54±47.28)pg/L,均P<0.05。联合组与介入组的不良反应总发生率对比,差异无统计学意义(31.25%比23.33%^[1], P>0.05)。联合组治疗后6个月的局部控制率、无进展生存率分别为81.25%、78.13%,均显著高于介入组的60.00%和60.00%(P<0.05)。联合组治疗12个月、24个月、36个月的总生存率比介入组更高(84.38%比76.67%、65.63%比46.67%、50.00%比33.33%),局部控制率比介入组更高(59.38%比40.00%、50.00%比33.33%、37.50% 比23.33%),无进展生存率也比介入组更高(56.25%比33.33%、46.88%比30.00%,34.38% 比16.67%),均P<0.05。结论 TACE联合大分割三维适形放疗治疗不可切除原发性肝癌可有效提高肝癌局部控制率,提高患者的中远期疗效,且患者的耐受性较好,安全性高,其作用机制可能与下调血清CXCL9、HSP90水平,抑制Wnt信号通路有关。

关键词: 经导管肝动脉化疗栓塞, 三维适形放疗, 原发性肝癌, 热休克蛋白90

Abstract: Objective To explore the clinical efficacy of transcatheter hepatic arterial chemoembolization (TACE) combined with large segment three-dimensional conformal radiotherapy in the treatment of unresectable primary liver cancer.Methods 62 patients with unresectable primary liver cancer were retrospectively selected and divided into two groups according to different treatment methods: 30 patients received TACE treatment (intervention group), and 32 patients received TACE combined with large segment three-dimensional conformal radiotherapy for treatment (combined group). The short-term efficacy, mid-term and long-term efficacy, adverse reactions, and changes in serum chemokine 9 (CXCL9) and heat shock protein 90 (HSP90) levels before and after treatment were compared between the two groups. Results The total effective rate of the combination group was similar to that of the intervention group (84.38% vs 76.67%, P>0.05). Compared with before treatment, the serum levels of CXCL9, HSP90, and β-catenin were significantly reduced in both groups after treatment. The serum levels of CXCL9, HSP90, and β-catenin in the combination group after treatment were (658.82±27.96) pg/mL, (0.04±0.01) ng/mL, and (264.52±51.46) pg/L, respectively, which were significantly lower than (760.82±30.64) pg/mL, (0.05±0.02) ng/mL and (390.54±47.28) pg/L in the intervention group, all P<0.05. There was no statistically significant difference in the total incidence of adverse reactions between the combination group and the intervention group (31.25% vs 23.33%^[2], P>0.05). The local control rate and progression free survival rate of the combined group at 6 months after treatment respectively were 81.25% and 78.13%, which were significantly higher than the 60.00% and 60.00% of the intervention group (P<0.05). The overall survival rate of the combined group at 12, 24, and 36 months of treatment was higher than that of the intervention group (84.38% vs 76.67%, 65.63% vs 46.67%, 50.00% vs 33.33%), the local control rate was higher than that of the intervention group (59.38% vs 40.00%, 50.00% vs 33.33%, 37.50% vs 23.33%), and the progression free survival rate was also higher than that of the intervention group (56.25% vs 33.33%, 46.88% vs 30.00%, 34.38% vs 16.67%), all P<0.05. Conclusion TACE combined with large segment three-dimensional conformal radiotherapy for unresectable primary liver cancer can effectively improve the local control rate of liver cancer, improve the mid-term and long-term efficacy of patients, and have good tolerance and high safety. Its mechanism of action may be related to downregulating serum CXCL9 and HSP90 levels, and inhibiting the Wnt signaling pathway.

Key words: Transcatheter hepatic arterial chemoembolization, Three-dimensional conformal radiotherapy, Primary liver cancer, Heat shock protein 90

栗明, 蒋著椿, 石永刚, 董世亮, 何自怀, 潘梅芳. 经导管肝动脉化疗栓塞联合大分割三维适形放疗治疗不可切除原发性肝癌的疗效评价[J]. 肝脏, 2023, 28(9): 1079-1083.

LI Ming, JIANG Zhu-chun, SHI Yong-gang, DONG Shi-liang, HE Zi-huai, PAN Mei-fang. Evaluation of the therapeutic effect of transcatheter hepatic artery chemoembolization combined with large segment three-dimensional conformal radiotherapy on unresectable primary liver cancer[J]. Chinese Hepatolgy, 2023, 28(9): 1079-1083.

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