摘要
目的 探讨载药微球经动脉化疗栓塞(D-TACE)联合局部热消融对肿瘤直径>7cm的肝细胞癌患者肿瘤血供调控及预后生存的影响。方法 回顾性纳入2021年1月至2024年6月新疆医科大学第一附属医院收治的150例肿瘤直径>7 cm的肝细胞癌患者,根据治疗方式的不同分为对照组(74例,采用传统碘化油TACE+微波消融)和观察组(76例,采用D-TACE+微波消融)。比较两组临床疗效、肿瘤血供[瘤组织血容量(BV)、对比剂平均通过时间(MTT)、血流量(BF)]、血清指标[血管内皮生长因子(VEGF)和基质金属蛋白酶9(MMP-9)]、并发症和生存期。结果 治疗后,观察组客观缓解率和疾病控制率高于对照组(P<0.05);治疗后,两组患者MTT均升高,而BV和BF均降低(P<0.05),且观察组肿瘤血供指标改善程度优于对照组(P<0.05);治疗后,两组患者VEGF、MMP-9水平均降低,且观察组更低(P<0.05);观察组并发症总发生率为3.95%,显著低于对照组的16.22%(P<0.05);KM分析显示,观察组中位总生存期42.13个月,高于对照组的30.12个月(HR=0.636,95%CI:0.570~0.745)(P<0.05)。结论 D-TACE联合局部热消融治疗肿瘤直径>7 cm的肝细胞癌患者效果良好,能够有效调控肿瘤血供,延长患者生存时间。
Objective To investigate the effect of drug-eluting bead transarterial chemoembolization(D-TACE)combined with local thermal ablation on tumor blood supply regulation and survival outcomes in patients with hepatocellular carcinoma(HCC)with tumor diameter>7 cm.Methods A total of 150 HCC patients with tumor diameter>7 cm admitted to the First Affiliated Hospital of Xinjiang Medical University between January 2021 and June 2024 were retrospectively enrolled.Based on the treatment method,patients were divided into a control group(n=74,treated with conventional lipiodol TACE plus microwave ablation)and an observation group(n=76,treated with D-TACE plus microwave ablation).The two groups were compared in terms of clinical efficacy,tumor blood supply parameters[blood volume(BV),mean transit time(MTT),blood flow(BF)],serum indicators[vascular endothelial growth factor(VEGF)and matrix metalloproteinase-9(MMP-9)],complications,and overall survival.Results After treatment,the objective response rate and disease control rate were higher in the observation group than in the control group(P<0.05).Post-treatment MTT increased in both groups,while BV and BF decreased(P<0.05),with greater improvement in tumor blood supply parameters in the observation group(P<0.05).VEGF and MMP-9 levels decreased in both groups after treatment,and were lower in the observation group(P<0.05).The total complication rate in the observation group was 3.95%,significantly lower than the 16.22%in the control group(P<0.05).Kaplan–Meier analysis showed that the median overall survival in the observation group was 42.13 months,longer than the 30.12 months in the control group(HR=0.636,95%CI:0.570–0.745,P<0.05).Conclusion D-TACE combined with local thermal ablation demonstrates favorable efficacy in the treatment of HCC patients with tumor diameter>7 cm,effectively regulates tumor blood supply,and prolongs survival.
作者
吾尔凯西·阿尔肯
顾俊鹏
朱帝文
李文化
李一帆
李运
WUERKAIXI·Aerken;GU Junpeng;ZHU Diwen;LI Wenhua;LI Yifan;LI Yun(Interventional Therapy Center,The First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang Uygur Autonomous Region 830000,China)
出处
《转化医学杂志》
2025年第10期115-119,共5页
Translational Medicine Journal
基金
新疆维吾尔自治区自然科学基金面上项目(2022D01C490)。
关键词
巨块型肝细胞癌
载药微球
肝动脉化疗栓塞
局部热消融
血供
预后
massive hepatocellular carcinoma
drug-eluting beads
transarterial chemoembolization
local thermal ablation
blood supply
prognosis
