摘要
目的 分析表观扩散系数值(ADC)联合循环肿瘤细胞(CTC)评估晚期肝癌经导管肝动脉化疗栓塞(TACE)联合程序性死亡受体-1(PD-1)抑制剂疗效的价值。方法 纳入2018年7月—2023年7月海安市中医院收治的晚期肝细胞癌(HCC)患者102例,均接受TACE联合PD-1抑制剂治疗。根据治疗2个月后疗效分为有效组和无效组,于治疗前及治疗1个月后,分别检测两组患者的ADC、CTC及治疗前后的差值(△)。筛查晚期HCC患者治疗反应性的影响因素,分析△ADC、△CTC对晚期HCC疗效的评估价值。结果 治疗后,102例晚期HCC患者中进展34例(33.33%),68例(66.67%)患者病情稳定或缓解。有效组CNLC分期IV期、肝功能Child-Pugh分级C级占比低于无效组[CNLC分期IV期占比分别为41.2%(28/68)和73.5%(25/34),Child-Pugh分级C级占比分别为20.6%(14/68)和52.9%(18/34)](P<0.05)。治疗后,有效组ADC高于无效组[分别为(2.3±0.5)mm^(2)/s和(1.9±0.4)mm^(2)/s],CTC低于无效组[分别为(19.3±2.9)和(34.5±3.8)](P<0.05);有效组△ADC[分别为(0.6±0.2)mm^(2)/s和(0.3±0.1)mm^(2)/s]、△CTC显著高于无效组[分别为(20.7±2.5)和(5.2±1.6)](P<0.05)。CNLC分期(OR=3.53,95%CI:1.20~10.31)、Child-Pugh分级(OR=3.22, 95%CI:1.10~9.43)、△ADC(OR=0.28, 95%CI:0.09~0.81)、△CTC(OR=0.21, 95%CI:0.07~0.61)均是晚期HCC患者治疗反应性的影响因素(P<0.05)。△ADC、△CTC单一及联合评估晚期HCC疗效的灵敏度分别为0.62、0.76、0.81,特异度分别为0.81、0.62、0.74,AUC分别为0.71、0.73、0.81。结论 晚期HCC患者治疗前后ADC及CTC变化评价TACE联合PD-1抑制剂的疗效的效能良好。
Objective To analyze the value of apparent diffusion coefficient(ADC)combined with circulating tumor cells(CTC)in evaluating the efficacy of transcatheter arterial chemoembolization(TACE)combined with programmed death receptor-1(PD-1)inhibitors for treating advanced liver cancer.Methods Between July 2018 and July 2023,102 patients with advanced hepatocellular carcinoma(HCC)admitted to Hai'an Hospital of Traditional Chinese Medicine who had received TACE combined with PD-1 inhibitors treatment were enrolled in this study.Based on the treatment efficacy after 2 months,the patients were divided into an effective group and an ineffective group.The ADC,CTC,and the difference(△)between the two groups of patients before and after one month of treatment were measured.The influencing factors of treatment responsiveness in patients with advanced HCC were screened,and the evaluation value of△ADC and△CTC for the treatment efficacy were analyzed.Results After treatment,34(33.33%)out of 102 advanced HCC patients progressed,and 68 patients(66.67%)showed stable or remission.The proportion of CNLC stage IV and Child Pugh grade C in the effective group was lower than that in the ineffective group[(41.2%(28/68)and 73.5%(25/34)in CNLC stage IV,and 20.6%(14/68)and 52.9%(18/34)in Child Pugh grade C,respectively)(P<0.05)].After treatment,the effective group had higher ADC than the ineffective group(2.3±0.5)mm^(2)/s and(1.9±0.4)mm^(2)/s,(respectively),while the CTC was lower than that of the ineffective group(19.3±2.9 and 34.5±3.8,respectively)(P<0.05);The effective group had significantly higher△ADC[(0.6±0.2)mm^(2)/s]and△CTC[(0.3±0.1)mm^(2)/s,respectively]compared to the ineffective group(20.7±2.5 and 5.2±1.6,respectively)(P<0.05).CNLC staging(OR=3.53,95%CI:1.20-10.31),Child Pugh grading(OR=3.22,95%CI:1.10-9.43),△ADC(OR=0.28,95%CI:0.09-0.81),and△CTC(OR=0.21,95%CI:0.07-0.61)are all influencing factors for treatment response in advanced HCC patients(P<0.05).The sensitivity and specificity of single and combined eval
作者
张宏娟
周恒琛
周建军
黄开红
ZHNAG Hong-juan;ZHOU Heng-chen;ZHOU Jian-jun;HUANG Kai-hong(Department of Radiology,Hai’an Hospital of Traditional Chinese Medicine,Jiangsu 226600,China;Department of Pharmacy,Hai’an Hospital of Traditional Chinese Medicine,Jiangsu 226600,China;Department of oncology,Hai’an Hospital of Traditional Chinese Medicine,Jiangsu 226600,China)
出处
《肝脏》
2024年第6期652-656,共5页
Chinese Hepatology
基金
江苏省高等学校基础科学(21KJA180001)。
关键词
肝细胞癌
经导管肝动脉化疗栓塞
免疫治疗
表观扩散系数值
循环肿瘤细胞
Hepatocellular carcinoma
Late stage
Transcatheter hepatic artery chemoembolization
Immunotherapy
Apparent diffusion coefficient value
Circulating tumor cell
