中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2013年
10期
728-733
,共6页
李臻%周进学%任建庄%张文靖%韩新巍
李臻%週進學%任建莊%張文靖%韓新巍
리진%주진학%임건장%장문정%한신외
癌,肝细胞%复发%化学栓塞,治疗性%131I美妥昔单克隆抗体
癌,肝細胞%複髮%化學栓塞,治療性%131I美妥昔單剋隆抗體
암,간세포%복발%화학전새,치료성%131I미타석단극륭항체
Carcinoma,hepatocellular%Recurrence%Chemoembolization,therapeutic%Iodine[131I]metuximab injection
目的 探讨131I美妥昔单克隆抗体联合经肝动脉化疗栓塞术(TACE)治疗中晚期肝细胞癌介入术后复发患者的临床价值. 方法 以60例中晚期肝细胞癌介入术后复发患者为研究对象,随机分为治疗组和对照组,各30例.对照组行常规TACE治疗,治疗组先经导管向靶血管注入指定剂量的131I美妥昔单克隆抗体后再行常规TACE治疗.术后1周复查肝功能、血常规、甲胎蛋白,并与术前进行比较.术后1个月及每隔2个月复查上述检查及腹部CT或磁共振平扫、增强扫描.比较两组患者的总有效率[(完全缓解例数+部分缓解例数+轻微缓解例数)÷总例数×100％]、反应率[(完全缓解例数+部分缓解例数+轻微缓解例数+无变化例数)÷总例数×100％]、疾病进展时间、总体生存时间、并发症及不良反应等情况.用Kaplan-Meier法进行生存分析,配对t检验分析术前、术后相关检查指标的变化,x2检验评价组间疗效的差别. 结果 治疗组和对照组分别失访6例和7例.与术前相比,术后1周时治疗组和对照组内的白细胞计数、血小板计数和甲胎蛋白水平差异均无统计学意义(P值均＞ 0.05),白蛋白水平明显降低(P值均＜0.05),胆红素水平明显升高(P值均＜ 0.05).治疗组和对照组平均疾病进展时间分别为(4.84±4.11)个月和(2.54±2.08)个月,差异有统计学意义(t=-2.13,P＜0.05)；中位生存时间分别为7.05个月和5.15个月,差异有统计学意义(x2=4.24,P＜0.05).治疗组部分缓解率、微缓解率、无变化率和疾病进展率分别为16.7％ (4/24)、37.5％ (9/24)、25.0％ (6/24)和20.8％ (5/24),对照组分别为8.7％ (2/23)、17.4％ (4/23)、21.7％ (5/23)和52.2％ (12/23).治疗组和对照组的有效率分别为54.2％ (12/24)和26.1％ (6/23),反应率分别为79.2％ (19/24)和47.8％ (11/23),差异有统计学意义(x2=3.85,P＜0.05).两组均无严重不良反应发生. 结论 TACE联合131I美妥昔单克隆抗体治疗肝细胞癌介入术后复发有一定疗效,可延长生存期及肿瘤进展时间,临床应用安全可行.
目的 探討131I美妥昔單剋隆抗體聯閤經肝動脈化療栓塞術(TACE)治療中晚期肝細胞癌介入術後複髮患者的臨床價值. 方法 以60例中晚期肝細胞癌介入術後複髮患者為研究對象,隨機分為治療組和對照組,各30例.對照組行常規TACE治療,治療組先經導管嚮靶血管註入指定劑量的131I美妥昔單剋隆抗體後再行常規TACE治療.術後1週複查肝功能、血常規、甲胎蛋白,併與術前進行比較.術後1箇月及每隔2箇月複查上述檢查及腹部CT或磁共振平掃、增彊掃描.比較兩組患者的總有效率[(完全緩解例數+部分緩解例數+輕微緩解例數)÷總例數×100％]、反應率[(完全緩解例數+部分緩解例數+輕微緩解例數+無變化例數)÷總例數×100％]、疾病進展時間、總體生存時間、併髮癥及不良反應等情況.用Kaplan-Meier法進行生存分析,配對t檢驗分析術前、術後相關檢查指標的變化,x2檢驗評價組間療效的差彆. 結果 治療組和對照組分彆失訪6例和7例.與術前相比,術後1週時治療組和對照組內的白細胞計數、血小闆計數和甲胎蛋白水平差異均無統計學意義(P值均＞ 0.05),白蛋白水平明顯降低(P值均＜0.05),膽紅素水平明顯升高(P值均＜ 0.05).治療組和對照組平均疾病進展時間分彆為(4.84±4.11)箇月和(2.54±2.08)箇月,差異有統計學意義(t=-2.13,P＜0.05)；中位生存時間分彆為7.05箇月和5.15箇月,差異有統計學意義(x2=4.24,P＜0.05).治療組部分緩解率、微緩解率、無變化率和疾病進展率分彆為16.7％ (4/24)、37.5％ (9/24)、25.0％ (6/24)和20.8％ (5/24),對照組分彆為8.7％ (2/23)、17.4％ (4/23)、21.7％ (5/23)和52.2％ (12/23).治療組和對照組的有效率分彆為54.2％ (12/24)和26.1％ (6/23),反應率分彆為79.2％ (19/24)和47.8％ (11/23),差異有統計學意義(x2=3.85,P＜0.05).兩組均無嚴重不良反應髮生. 結論 TACE聯閤131I美妥昔單剋隆抗體治療肝細胞癌介入術後複髮有一定療效,可延長生存期及腫瘤進展時間,臨床應用安全可行.
목적 탐토131I미타석단극륭항체연합경간동맥화료전새술(TACE)치료중만기간세포암개입술후복발환자적림상개치. 방법 이60례중만기간세포암개입술후복발환자위연구대상,수궤분위치료조화대조조,각30례.대조조행상규TACE치료,치료조선경도관향파혈관주입지정제량적131I미타석단극륭항체후재행상규TACE치료.술후1주복사간공능、혈상규、갑태단백,병여술전진행비교.술후1개월급매격2개월복사상술검사급복부CT혹자공진평소、증강소묘.비교량조환자적총유효솔[(완전완해례수+부분완해례수+경미완해례수)÷총례수×100％]、반응솔[(완전완해례수+부분완해례수+경미완해례수+무변화례수)÷총례수×100％]、질병진전시간、총체생존시간、병발증급불량반응등정황.용Kaplan-Meier법진행생존분석,배대t검험분석술전、술후상관검사지표적변화,x2검험평개조간료효적차별. 결과 치료조화대조조분별실방6례화7례.여술전상비,술후1주시치료조화대조조내적백세포계수、혈소판계수화갑태단백수평차이균무통계학의의(P치균＞ 0.05),백단백수평명현강저(P치균＜0.05),담홍소수평명현승고(P치균＜ 0.05).치료조화대조조평균질병진전시간분별위(4.84±4.11)개월화(2.54±2.08)개월,차이유통계학의의(t=-2.13,P＜0.05)；중위생존시간분별위7.05개월화5.15개월,차이유통계학의의(x2=4.24,P＜0.05).치료조부분완해솔、미완해솔、무변화솔화질병진전솔분별위16.7％ (4/24)、37.5％ (9/24)、25.0％ (6/24)화20.8％ (5/24),대조조분별위8.7％ (2/23)、17.4％ (4/23)、21.7％ (5/23)화52.2％ (12/23).치료조화대조조적유효솔분별위54.2％ (12/24)화26.1％ (6/23),반응솔분별위79.2％ (19/24)화47.8％ (11/23),차이유통계학의의(x2=3.85,P＜0.05).량조균무엄중불량반응발생. 결론 TACE연합131I미타석단극륭항체치료간세포암개입술후복발유일정료효,가연장생존기급종류진전시간,림상응용안전가행.
Objective To evaluate the clinical value of iodine[131I] metuximab infusion combined with transcatheter arterial chemoembolization (TACE) for treating cases of post-intervention relapse of mid or advanced stage hepatocellular carcinoma (HCC).Methods Sixty patients who were diagnosed between March 2009 and June 2010 with relapse of mid or advanced stage HCC following previous intervention with various standard clinical methods were recruited for study.The patients were randomlyand equally divided into a control treatment group (CG; receiving TACE therapy alone) and an experimental treatment group (TG; receiving TACE combined with iodine [131I] metuximab injection).For all patients,licartin was first perfused into the tumor feeding artery and then the TACE procedure was performed 20 min later.Liver function markers and routine blood parameters,including alpha-fetoprotein (AFP) and clotting time,were examined at one week and one month after the treatment.Enhanced computed tomography or magnetic resonance imaging of the liver was performed at one month after treatment and thereafter on a bi-monthly follow-up schedule.The World Health Organization's tumor evaluation standard was used to assess the therapeutic effects in each group.Results of laboratory tests (pre-and post-treatment),reported complications,and side-effects were evaluated for their contributions to time of tumor progression (TTP)and survival time.Results Patients in the TG and CG groups had similar blood cell counts at pre-operative and 1-week postoperative time points.The TG group showed a significantly reduced level of AFP following treatment,but it was not significantly different from the level in the CG group.The TG group did however show significantly different levels of liver functional parameters (all P ＜ 0.05) and significantly higher TTP (4.84 ± 4.11 vs.CG:2.54 ± 2.08 months; t =-2.13,P ＜ 0.05) and average survival time (7.05 vs.5.15 months;x2 =4.24,P =0.039).The rates of partial response (PR),slight remission (MR),unchanged status (SD) and progressive disease (PD)were 16.7％,37.5％,25.0％ and 20.8％ in the TG group,and 8.7％,17.4％,21.7％ and 52.2％ in the CG group.The therapeutic effect rate (CR + PR + MR) and reaction rate (CR + PR + MR + SD) was significantly different between the two groups (P =0.048).No serious adverse effects were reported.Conclusion TACE combined with iodine [131I] metuximab injection is a safe and effective procedure for prolonging the survival and TTP of patients with HCC relapse following prior therapeutic intervention.
