| Objective:To study the efficacy and prognosis of piroxacin combined with drug-loaded microspheres and iodide oil in the treatment of primary liver cancer patients with percutaneous hepatic arterial chemoembolization(TACE),so as to select a more appropriate treatment for the clinic and patients.Materials and Methods:120 patients with primary liver cancer treated with TACE in our hospital were fully selected and randomly divided into the iodide group(pirubital combined with iodide,group A,60 cases)and the microsphere group(pirubital combined with drug delivery microsphere,group B,60 cases).To investigate the effect of patients before and after treatment;Liver function,blood routine,renal function,AFP,child-pugh grading and other indexes were observed before and 1 month after TACE treatment.Changes of AFP,ALB,TBIL,AST and ALT levels in the two groups before and after treatment;The dynamic rate of leukocyte decline,the incidence of bone marrow suppression,the disease control rate and the objective remission rate were observed.Cellular immune status analysis of patients in each group;The results of MRI examination 1 month after the operation were recorded.Postoperative complications,including vomiting,fever and pain,were recorded.Survival rate and median survival after 1 and 2 yearsResults:Clinical baseline data analysis:mean age,sex ratio,history of hepatitis b,BLCL stage,child-pugh grade,KPS score,history,tumor number and tumor size of each group were analyzed.Studies suggest that in the above two groups of PHC patients baseline data difference is small,P values were 0.309,0.119,0.099,0.089,0.098,0.118,0.090,0.113,0.095 and 0.078,were greater than 0.05,no statistically significant difference data;Recent curative effect evaluation:preoperative liver and kidney function assessment:two groups of patients with liver and kidney function index of albumin,total bilirubin,Hb,PLT,ALT,AST,TBIL and propagated data analysis preoperative index difference is small,between the two groups of data analysis,P values were 0.120,0.804,0.098,0.190,0.126,0.098,0.133,0.065,were greater than 0.05,no statistically significant difference data;Each January kidney function after surgery for patients with PHC albumin,total bilirubin,Hb,PLT,ALT,AST,TBIL and propagated data analysis showed the same trend,the comparison between two groups of data,P values were 0.056,0.834,0.112,0.214,0.123,0.107,0.134,0.056,were greater than 0.05,no statistically significant difference data;Analysis of concentration of tumor serum markers:AFP:with the extension of postoperative time,the serum concentration of PHC patients in the two groups showed a decreasing trend,and the overall decreasing trend of patients in the DEB group was more obvious.Compared with each group,P<0.05 showed statistically significant difference.Oncoembryonic antigen:with the extension of postoperative time,the serum concentrations of oncoembryonic antigen in the two groups of PHC patients showed a decreasing trend,and the overall decreasing trend was more obvious in the DEB group.Compared with each group,P<0.05 showed statistically significant differences.CA125:with the extension of postoperative time,the serum CA125 concentration in PHC patients in the two groups showed a decreasing trend,and the overall decreasing trend of patients in the DEB group was more obvious.Comparing the data of each group,P<0.05 showed statistically significant difference.Cyfra21-1:with the extension of postoperative time,the serum expression of cyfra21-1 in PHC patients in the two groups showed a decreasing trend,and the overall decreasing trend of patients in the DEB group was more obvious.Compared with each group,P<0.05 showed statistically significant difference.Toxic and side effects:PHC patients after TACE often had adverse reactions such as abdominal pain and discomfort,fever,malignancy,vomiting,fatigue,diarrhea,etc.The postoperative statistics of both groups showed obvious IV degree toxic and side effects.Research suggests in the project analysis,two groups of patient data difference is small,P values were 0.129,0.811,0.133,0.212,0.144,0.107,were greater than 0.05,no statistically significant difference data;The adverse reactions in both groups were significantly relieved or improved after effective treatment.Analysis of vascular changes:both the traditional TACE operation and the DEB TACE operation went smoothly.DSA imaging showed that the embolization was successful in the two groups,and the chemotherapy drugs were diffused and released in the hepatic artery of the patients.After TACE,PHC patients in the two groups were improved to a certain extent,and the tumor was controlled to a certain extent.Among them,PHC patients in the DEB group were able to get a greater degree of drug infiltration in the hepatic artery,and their condition recovered well.After TACE,tumor blood vessels of PHC patients in the two groups decreased to a certain extent,and the proportion of DEB group was higher.The proportion of tumor blood vessels increased in the traditional TACE group was higher than that in the DEB group,with a statistical P value of 0.023 and statistically significant difference.Analysis of immunological index:SⅡ analysis of systemic immunology-inflammation index:with the extension of time after TACE,the SII index of PHC patients in both groups decreased to a certain extent,and the decreasing trend was more obvious in DEB group.Compared with PHC patients in the two groups at each time period,P<0.05,the data difference was statistically significant.Leucocyte dynamic change rate:the leucocyte dynamic changes of PHC patients in each group before,1 week after,2 weeks after,4 weeks after,8 weeks after,10 weeks after and 12 weeks after the surgery were all within the normal range.The comparison between the two groups showed that the difference was not statistically significant(P>0.05).Long-term efficacy evaluation:disease control rate:the proportion of complete remission and partial remission in PHC patients in DEB group was higher than that in iodized oil TACE group,and the proportion of disease progression was lower,with a statistical P value of 0.010.In terms of overall efficiency and disease control rate,the DEB group was significantly better than the traditional iodide group.The statistical P values were 0.042 and 0.030,both less than 0.05,indicating statistically significant differences.3 months after surgery:the proportion of complete remission and partial remission in PHC patients in DEB group was higher than that in iodide TACE group,and the proportion of disease progression was lower,with a statistical P value of 0.020.In terms of the overall efficiency and disease control rate,the DEB group was significantly better than the traditional iodide group.The statistical P values of the DEB group were 0.023 and 0.034,both less than 0.05,indicating statistically significant differences.With the extension of chemotherapy time,the ORR and DCR data analysis of the effective rate of the two groups showed a downward trend,and the ORR value of the DEB group was still higher than that of the iodide group at each time period.The comparison between the data of each group showed P<0.05,indicating statistically significant differences.Survival analysis:by the end of the follow-up,a total of 42 PHC patients had died,including 25 in the iodide group and 17 in the DEB group.The median survival time of patients in the iodide group and DEB group was 13.5 months and 11 months,respectively.The progression-free survival of PHC patients in both the iodide group and the DEB group was about 9 months.The data of the DEB group were relatively lower.PFS data of the two groups were compared,P=0.034.The data difference was statistically significant.Life quality evaluation:KPS:June,preoperative and postoperative KPS score increased in both groups,the patient’s quality of life gradually improved,effectively alleviate illness,postoperative 6～12 month after month,KPS score decrease trend,DEB score of patients than iodine oil group,P values were 0.078,0.046,0.035,0.042,0.090,after one month～June after data analysis,difference have statistical significance;ECGO score:the ECOG score of the two groups gradually decreased from the preoperative to the postoperative 6 months,and the ECOG score showed an increasing trend from the postoperative 6 months to the postoperative 12 months.The score of the DEB group was lower than that of the iodide group,with P values of 0.900,0.040,0,014.0.002,0.089,respectively.SF-36:preoperative and postoperative in June,two groups of patients with SF-36 scale increasing,6～12 month after month after surgery,SF-36 scale appears to reduce the trend,DEB overall score of patients is higher than the traditional group,with conventional P values were 0.112,0.045,0.030,0.012,0.090,0.108,after one month～June after data analysis,the difference is statistically significant;Complications of statistical analysis:two groups of patients with hepatic artery injury,liver parenchyma injury,cholecystitis and gall bladder perforation,miss hua pneumonia,spinal cord injury,intractable hiccups,liver failure and hepatic encephalopathy and hepatorenal syndrome and other complications were less likely to happen,differences between groups of data also small,P values were 0.199,0.113,0.130,0.190,0.103,0.167,0.089,0.097,0.190,0.345,were greater than 0.05,no statistically significant difference data;COX univariate and multivariate regression analysis of overall survival of PHC patients:in univariate analysis,ECGO score,KPS score,SII index,and DEB were all key factors affecting the overall survival of PHC patients.The same trend was reflected in the multi-factor data analysis.ECGO score,KPS score,SⅡ index,and DEB surgery were all key factors affecting the overall survival of PHC patients.The P values were 0.024,0.015,0.040,and 0.030,respectively,which were all less than 0.05Conclusions:(1)The two groups of PHC patients before the operation presented the same clinical baseline data,and the two groups had the same gender data in terms of average age,sex ratio,tumor size,tumor number,KPS score,previous treatment history and other items,which provided certain basis for the following study.(2)With the traditional carrier drug microsphere embolization iodine oil embolization can effectively reduce the middle-late PHC patients’ serum tumor markers AFP,carcinoembryonic antigen expression,CA125,Cyfra21-1 concentration,reduce the patient’s body immune system-inflammation index expression,reduce the probability of occurrence of adverse reaction and complications,effective control of the development of tumor,improve the median surial in patients with and progression-free surial,give clinical must be inspired.(3)Compared with traditional iododol embolization,drug-loaded microsphere embolization can effectively improve the quality of life in advanced PHC patients and reduce the mortality;ECGO score,KPS score,SⅡ index and treatment method are the key factors affecting the overall survival of PHC patients. |
PDF Full Text Request