肝癌肝移植术前降期中载药微球经动脉化疗栓塞应用效果观察

doi:10.3969/j.issn.1006-6233.2023.07.024

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摘要 目的: 探究载药微球经动脉化疗栓塞(DEB-TACE)与常规经动脉化疗栓塞术(cTACE)在肝癌肝移植术前降期治疗中的应用价值。方法: 选取2015年1月至2022年1月我院74例因肝细胞性肝癌(HCC)行经典原位肝移植患者的临床资料,开展回顾性研究。其中36例肝移植术前行DEB-TACE降期治疗,作为DTACE组,38例肝移植术前行cTACE降期治疗,作为cTACE组。比较两组降期治疗疗效、血清肿瘤标志物[甲胎蛋白(AFP)、糖类抗原199(CA199)、E-钙黏蛋白(EC)]、肝功能指标[天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)]、预后相关标志物[血管内皮生长因子(VEGF)、分泌型蛋白Dickkopf-1(DKK1)、CD24]、不良反应发生率、肝移植术后1年复发转移情况,采用酶联免疫吸附法检测血清VEGF、DKK1、CD24水平。结果: DTACE组降期治疗缓解率(83.33%)与cTACE组(71.05%)对比差异无统计学意义(P>0.05);DTACE组治疗后血清AFP、CA199、EC水平均低于cTACE组,差异具有统计学意义(P<0.05);DTACE组治疗后血清AST、TBIL、ALT水平均低于cTACE组,差异具有统计学意义(P<0.05);DTACE组治疗后血清VEGF、DKK1、CD24水平均低于cTACE组,差异具有统计学意义(P<0.05);DTACE组恶心/呕吐、腹痛、发热、肝脓肿发生率(11.11%、16.67%、69.44%、2.78%)与cTACE组(18.42%、21.05%、76.32%、7.89%)对比差异无统计学意义(P>0.05);DTACE组肝移植术后1年复发率、转移率(5.56%、10.53%)与cTACE组(11.11%、18.42%)对比差异无统计学意义(P>0.05)。结论: 肝癌肝移植术前降期治疗中采用DEB-TACE与cTACE均能获得良好治疗效果,其中DEB-TACE能更明显下调血清肿瘤标志物及预后相关标志物水平,在保护肝功能方面具有明显优势。

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关键词 ：肝细胞性肝癌, 肝移植术, 降期治疗, 载药微球, 经动脉化疗栓塞

Abstract：Objective: To investigate the value of drug-laden microsphere transarterial chemoembolization (DEB-TACE) versus conventional transarterial chemoembolization (cTACE) in the preoperative descending treatment of liver cancer liver transplantation. Methods: The clinical data of 74 patients who underwent classical in situ liver transplantation for hepatocellular carcinoma (HCC) in our hospital from January 2015 to January 2022 were collected for a retrospective study.Among them,36 cases underwent DEB-TACE downstaging treatment before liver transplantation as the DTACE group and 38 cases underwent cTACE downstaging treatment before liver transplantation as the cTACE group.The efficacy of the step-down treatment,serum tumor markers[alpha-fetoprotein (AFP),glycoantigen 199 (CA199),E-calcine mucin (EC)],liver function indexes[aspartate aminotransferase (AST),total bilirubin (TBIL),alanine aminotransferase (ALT)],prognosis-related markers[vascular endothelial growth factor (VEGF),secretory protein Dickkopf-1 (DKK1),CD24],incidence of adverse events,and recurrent metastases 1 year after liver transplantation. Results: There was no statistically significant difference (P>0.05) between the remission rate of the DTACE group on descending treatment (83.33%) and the cTACE group (71.05%); serum AFP,CA199 and EC levels were lower in the DTACE group than in the cTACE group after treatment (P<0.05).Serum AST,TBIL and ALT levels were lower in the DTACE group than in the cTACE group after treatment (P<0.05); serum VEGF,DKK1 and CD24 levels were lower in the DTACE group than in the cTACE group after treatment (P<0.05).There was no statistically significant difference in the incidence of nausea/vomiting,abdominal pain,fever,and liver abscess in the DTACE group (11.11%,16.67%,69.44%,2.78%) compared with the cTACE group (18.42%,21.05%,76.32%,7.89%) (P>0.05); the recurrence rate and metastasis rate 1 year after liver transplantation in the DTACE group ( 5.56%,10.53%) compared with the cTACE group (11.11%,18.42%) were not statistically significant (P>0.05). Conclusion: Both DEB-TACE and cTACE can achieve good therapeutic effects in the preoperative descending treatment of liver cancer liver transplantation,among which DEB-TACE can more significantly downregulate serum tumor markers and prognosis-related markers levels,and has obvious advantages in protecting liver function.

Key words： Hepatocellular carcinoma Liver transplantation Step-down therapy Drug-laden microspheres Transarterial chemoembolization

基金资助:河北青年科技课题,(编号:20190661)

通讯作者: 窦剑

引用本文:

刘保旺, 窦剑, 王洋, 陈雅洁, 刘文鹏, 赵鑫, 曾强, 曹经琳. 肝癌肝移植术前降期中载药微球经动脉化疗栓塞应用效果观察[J]. 河北医学, 2023, 29(7): 1183-1187.
LIU Baowang, DOU Jian, WANG Yang, et al. Effectiveness of Transarterial Chemoembolization with Drug-Laden Microspheres in the Preoperative Descending Phase of Liver Transplantation for Hepatocellular Carcinoma. HeBei Med, 2023, 29(7): 1183-1187.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2023.07.024 或 http://www.hbyxzzs.cn/CN/Y2023/V29/I7/1183

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