两种方法治疗肝癌并门静脉癌栓患者的microRNA-363水平变化及疗效对比

Effect of ultrasound-guided 125I seed implantation combined with TACE on microRNA-363 level and prognosis in hepatocellular carcinoma with portal vein tumor thrombus

摘要:

目的 分析超声引导下¹²⁵I粒子条植入联合经导管动脉化疗栓塞术（TACE）治疗肝癌并门静脉癌栓对microRNA-363（miR-363）水平及预后的影响。方法 选取2016年11月—2020年10月就诊于南阳医学高等专科学校第一附属医院的100例肝癌并门静脉癌栓患者，按随机数字表法分为TACE组和联合组，每组50例。TACE组接受单纯TACE治疗，联合组在TACE组治疗的基础上联合超声引导下¹²⁵I粒子条植入治疗。比较两组临床疗效、miR-363、甲胎蛋白（AFP）、谷丙转氨酶（ALT）、术后并发症、预后、生活质量综合评定问卷（GQOLI-74）评分。结果 联合组临床疗效总有效率高于TACE组（P <0.05）。联合组手术前后miR-363相对表达量、ALT的差值大于TACE组，AFP小于TACE组（P <0.05）。两组并发症总发生率比较，差异无统计学意义（P >0.05）。两组术后1年生存率、复发率和术后3年复发率比较，差异无统计学意义（P >0.05），联合组术后3年生存率高于TACE组（P <0.05）。联合组手术前后GQOLI-74评分的差值大于TACE组（P <0.05）。结论 超声引导下¹²⁵I粒子条植入联合TACE可提高肝癌并门静脉癌栓患者疗效，改善肝功能，上调miR-363水平，提高生活质量，对中期预后有积极作用，且并发症风险较低。

Abstract:

Objective To analyze the effect of ultrasound-guided ¹²⁵I seed implantation combined with transcatheter arterial chemoembolization (TACE) on the level of microRNA-363 (miR-363) and prognosis in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus.Methods A total of 100 patients with HCC and portal vein tumor thrombus who were treated in First Affiliated Hospital of Nanyang Medical College from November 2019 to October 2020 were selected and divided into two groups according to the random number table with 50 cases in each group. The TACE group received TACE treatment alone, while the combined group was additionally treated with ultrasound-guided ¹²⁵I seed implantation on the basis of TACE. The clinical efficacy, serum indicators [miR-363, alpha-fetoprotein (AFP), and alanine aminotransferase (ALT)], postoperative complications, prognosis, and Generic Quality of Life Inventory-74 (GQOLI-74) score were evaluated.Results The overall effective rate of combined group was higher than that of TACE group (P < 0.05). The differences of miR-363 and ALT before and after treatment were higher in combined group than those in TACE group, while the difference of AFP was lower in the combined group than that in TACE group (P < 0.05). There was no difference in the incidence of postoperative complications between the combined group and the TACE group (P > 0.05). The 1-year survival rate and the recurrence rate at 1 year and 3 years after the operation were not different between the two groups (P > 0.05), while the 3-year survival rate of the combined group was higher than that of the TACE group (P < 0.05). Besides, the differences in GQOLI-74 scores before and after the treatment of the combined group were higher than those of the TACE group (P < 0.05).Conclusions Ultrasound-guided ¹²⁵I seed implantation combined with TACE exhibits better therapeutic efficacy in HCC with portal vein tumor thrombus. It can enhance the liver function, upregulate miR-363 level, and improve the quality of life, with a positive effect on the medium-term prognosis and a lower risk of complications.