^(125)I放射性粒子植入治疗TACE抵抗肝细胞癌的临床疗效  

Radioactive I-125 seed implantation in treatment of TACE-refractory hepatocellular carcinoma

作　　者：吴镜强 黄文薮 郭永建 周静文[1] 蔡明岳 梁礼聪 黄敬君 练辉[1] 何明基[1] 朱康顺 Wu Jingqiang;Huang Wensou;Guo Yongjian;Zhou Jingwen;Cai Mingyue;Liang Licong;Huang Jingjun;Lian Hui;He Mingji;Zhu Kangshun(Department of Minimally Invasive Interventional Radiology,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China)

机构地区：[1]广州医科大学附属第二医院微创介入科,广州510260

出　　处：《中华肝胆外科杂志》2021年第8期570-574,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(81873920)。

摘　　要：目的探讨125I放射性粒子植入治疗经导管肝动脉栓塞化疗(TACE)抵抗肝细胞癌的临床疗效。方法回顾性分析2016年7月1日至2019年8月31日期间广州医科大学附属第二医院新确诊为肝细胞癌并行TACE治疗后发生TACE抵抗的70例患者的临床资料。29例患者发生TACE抵抗后行125I放射性粒子植入治疗(125I粒子组);41例患者继续行TACE治疗(TACE组)。比较两组患者的客观缓解率、无肿瘤进展时间(PFS)、生存时间、整体生存时间,分析影响患者生存的因素。结果共70例肝细胞癌患者纳入研究,其中男性59例,女性11例,年龄(60.5±11.9)岁。治疗后1、3、6个月时,125I粒子组的客观缓解率分别为20.7%、40.7%、34.6%,高于TACE组(2.6%、3.3%、5.0%),差异有统计学意义(P<0.05)。125I粒子组的PFS、生存时间、整体生存时间分别为7.6、21.1、32.1个月,高于TACE组的3.5、8.5、14.8个月,差异有统计学意义(P<0.05)。125I粒子组和TACE组术后栓塞综合征发生率分别为93.1%(27/29)和100.0%(41/41),差异无统计学意义(P>0.05)。Child-Pugh分级B级(HR=0.311,95%CI:0.160~0.603,P=0.005)和TACE(HR=0.308,95%CI:0.159~0.597,P=0.002)是影响生存时间的独立危险因素。结论125I放射性粒子植入治疗TACE抵抗肝细胞癌的安全性和疗效均较好,与单纯TACE治疗比较可显著提高患者的生存。Objective To study the use of radioactive I-125 seed implantation in the treatment of transarterial chemoembolization(TACE)-refractory hepatocellular carcinoma(HCC).Methods A retrospective study was conducted on 70 patients with HCC who were initially treated with TACE between July 1,2016 and August 31,2019 at the Second Affiliated Hospital of Guangzhou Medical University.After these patients were found to be refractory to TACE,29 patients were converted to radioactive I-125 seed implantation(the 125I seed group),and 41 patients were continued with TACE(the TACE group).The objective response rate,progression-free survival(PFS),overall survival(OS),total overall survival(TOS)of the two groups were compared.Results There were 59 males and 11 females,aged(60.5±11.9)years in this study.At 1,3,6 months after treatment,the objective response rates of the 125I seed group were 20.7%,40.7%,34.6%,respectively,which were significantly higher than that of the TACE group of 2.6%,3.3%,5.0%,respectively.The PFS,OS,TOS in the 125I seed group were 7.6,21.1,32.1 months,respectively,which were significantly better when compared with the TACE group(3.5,8.5,14.8 months,respectively,all P<0.05).There was no significant difference in the embolization syndrome between the two groups[93.1%(27/29)vs 100.0%(41/41),P>0.05].Child-Pugh B grading(HR=0.311,95%CI:0.160-0.603,P=0.005)and TACE(HR=0.308,95%CI:0.159-0.597,P=0.002)were independent risk prognostic factors for survival.Conclusion This study showed better treatment efficacy and safety using radioactive I-125 seed implantation in TACE-refractory HCC and this treatment significantly improved survival of patients when compared with TACE alone.

关 键 词：癌 肝细胞 近距离放射疗法 ^(125)I放射性粒子 

分 类 号：R735.7[医药卫生—肿瘤]