放射性125I粒子植入联合肝动脉化疗栓塞术治疗中晚期肝癌的临床疗效评价

Efficacy evaluation of radioactive 125I seeds implantation combined with transcranial arterial chemoembolization in the treatment of advanced liver cancer

    摘要
  • 摘要:
    目的 评价放射性125I粒子植入联合肝动脉化疗栓塞术（TACE）治疗中晚期肝癌的临床疗效。
    方法 回顾性分析2014年1月至2019年12月于兰州市第一人民医院经穿刺活体组织病理学检查证实的123例中晚期肝癌患者的临床资料，其中男性73例、女性50例，年龄39~75（60.4±4.4）岁。以接受放射性125I粒子植入联合TACE治疗的患者为治疗组（69例），以接受单纯TACE治疗的患者为对照组（54例）。采用视觉模拟评分法（VAS）对所有患者进行疼痛评估，依据改良的实体瘤疗效评价标准（mRECIST）1.1版进行疗效评估。采用χ2检验进行2组间的比较。
    结果 治疗后1个月治疗组疼痛频率≤2次/d的患者占94.2%（65/69）、≥3次/d的患者占5.8%（4/69），对照组疼痛频率≤2次/d的患者占70.4%（38/54）、≥3次/d的患者占29.6%（16/54），2组间的差异有统计学意义（χ2=123.00，P<0.001）。治疗后1个月治疗组无痛和轻度疼痛患者占71.0%（49/69）、中度疼痛占24.6%（17/69）、重度疼痛占4.4%（3/69），对照组无痛和轻度疼痛的患者占46.3%（25/54）、中度疼痛占40.7%（22/54）、重度疼痛占13.0%（7/54），2组间的差异有统计学意义（χ2=8.480，P<0.05）。治疗组患者治疗后3个月的治疗有效率和疾病控制率分别为84.1%（58/69）和92.8%（64/69），显著高于对照组的22.2%（12/54）和51.9%（28/54），2组间的差异均有统计意义（χ2=47.234、36.883，均P<0.001）；治疗后6个月的治疗有效率和疾病控制率分别为62.3%（43/69）和79.7%（55/69），显著高于对照组的16.7%（9/54）和44.4%（24/54），2组间的差异均有统计意义（χ2=25.871、17.999，均P<0.001）。治疗组患者治疗后1年和2年的生存率分别为75.4%（52/69）和40.6%（28/69）、对照组分别为33.3%（18/54）和13.0%（7/54），2组间的差异均有统计学意义（χ2=21.821、11.349，均P<0.001）。
    结论 放射性125I粒子植入联合TACE治疗对中晚期肝癌患者具有良好的治疗效果。

     

    Abstract:
    Objectives To evaluate the clinical efficacy of radioactive 125I seed implantation combined with transcranial arterial chemoembolization (TACE) in the treatment of advanced liver cancer.
    Methods A total of 123 patients with advanced liver cancer by histopathology in the First People's Hospital of Lanzhou City, from January 2014 to December 2019 were retrospectively analyzed. The patients included 73 male patients and 50 female patients, aged 39−75(60.4±4.4) years old. Herein, patients who received radioactive 125I seed implantation combined with TACE were treated as the treatment group (69 cases), meanwhile, patients who received TACE alone were treated as the control group (54 cases). The visual analog scale (VAS) was used to evaluate the pain of all patients, and the efficacy was evaluated based on the modified Response Evaluation Criteria for Solid Tumors (mRECIST) version 1.1. χ2 test was used to compare the two groups.
    Results After 1 month of treatment, 94.2%(65/69) of patients in the treatment group had pain frequency of ≤2 times/d, and 5.8%(4/69) of patients with pain frequency of ≥3 times/d. Meanwhile, 70.4%(38/54) of patients in the control group had pain frequency of ≤2 times/d, and 29.6%(16/54) of patients with pain frequency of ≥3 times/d. Hence, the difference between the two groups was statistically significant (χ2=123.00, P<0.001). After 1 month of treatment, 71.0%(49/69) of patients in the treatment group had no pain or mild pain, 24.6%(17/69) had moderate pain, and 4.4%(3/69) had severe pain. Meanwhile, in the control group, 46.3%(25/54) of patients had no pain or mild pain, 40.7%(22/54) experienced moderate pain, and 13.0%(7/54) had severe pain. Thus, the difference between the two groups was statistically significant (χ2=8.480, P<0.05). After 3 months of treatment, the effective rate and disease control rate of the treatment group were 84.1%(58/69) and 92.8%(64/69), respectively, which were significantly higher than those of the control group (22.2%(12/54) and 51.9%(28/54)), and the differences were statistically significant (χ2=47.234, 36.883; P<0.001). After 6 months of treatment, the effective rate and disease control rate of the treatment group were 62.3%(43/69) and 79.7%(55/69), respectively, which were significantly higher than 16.7%(9/54) and 44.4%(24/54) of the control group, and the differences between the two groups were statistically significant (χ2=25.871, 17.999; both P<0.001). In addition, the 1- and 2-year survival rates were 75.4%(52/69) and 40.6%(28/69) in the treatment group and 33.3%(18/54) and 13.0%(7/54) in the control group, respectively, and the difference was statistically significant (χ2=21.821, 11.349; both P<0.001).
    Conclusion Radioactive 125I seed implantation combined with TACE treatment therapy has a good therapeutic effect on patients with advanced liver cancer.

     

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