| Objective:To explore the value of the assessment and guiding significance of mutislice CT in advanced primary hepatocellular carcinoma, according to standard of mRECIST, which after the treatment of sorafenib combined with TACE.Material and methods:retrospective analysis of the clinical data of the patients with middle and advanced primary hepatocellular carcinoma, who were diagnosed and treated in our hospital. The inclusion criteria included:1) all patients were diagnosed with middle and advanced primary hepatocellular carcinoma by clinical, MSCT, and pathological;2) Child-Pugh A/B;3) all of them were treated by TACE;4) took enhanced CT examination2weeks ago before the treatment and1month,3month,5month respectively after the treatment;5) the survival time must be more than6months. The patients were included in the experimental group, named "sorafenib combine with TACE", with took the oral medication of sorafenib more than3months. And the other patients were included in control group, named "simply TACE therapy", without the treatment of sorafenib. There were20patients(17male,3female, average51.00±12.69years) included in the experimental group,8were Child-Pugh A,12were Child-Pugh B, all of them took the sorafenib1month later after the TACE therapy,2times daily, continuous at least3months. There were20patients(18male,2female, average52.5±14.35years) included in the control group,9were Child-Pugh A,11were Child-Pugh B.Summed and analysed the image data of MSCT before treatment and1month,3months,5months after therapy, respectively, in the two group, which included:1) the survival and necrosis of the tumor;2) whether systematic recurrence or not;3) residual lesions and blood supply(included Venous cancerous embolus and lymphoglandula);4) Determined the target lesion, measured the maximum diameters and the value of CT of it, avoided liquefied necrotic area and iodine oil deposit area;5) calculated the reduce rate of the average maximum diameters(D), liver metastasis or recurrence had focal (IMR)/IRR, extrahepatic metastasis rate(EMR), disease control rate(DCR). Compared the curative effect of the two projects, and assessed the worth of MSCT for evaluated effective of the treatment, according to the analysis.Results:1. MSCT evaluation results from the study:1months later, the results of experimental group and matched group were:(1) the narrowing rate of average maximum diameter line of target lesion respectively as shown below:(40.45±36.84)%and (30.13±65.77)%, t=0.621, P=0.544, it had not statistically difference between the two.(2) The intrahepatic metastasis or recurrence rate respectively was0%and5%, the data of control group was higher than the experimental group,but P=1.00, it had not statistically difference between the two.(3)The extrahepatic metastasis rate (EMR) respectively was10%and10%, but P=1.00, it had not statistically difference between the two.(4) The assessment results of mRECIST respectively as shown below:CR had3cases and2cases, PR had9cases and11cases, SD had7cases and5cases, PD had1cases and2cases.And the Clinical benefit rate (CBR) of this two group respectively was95%and90%, but P=1.00, it had not statistically difference between the two.3months later, the results of experimental group and matched group were:(1) the narrowing rate of average maximum diameter line of target lesion respectively as shown below:(20.81±37.52)%and (7.37±92.01)%, P=0.549, it had not statistically difference between the two.(2) The intrahepatic metastasis or recurrence rate respectively was0%and20%, the data of control group was higher than the experimental group,but P=0.106, it had not statistically difference between the two.(3)The extrahepatic metastasis rate (EMR) respectively was10%and15%, but P=1.00,they have no difference in statistically.(4) The assessment results of mRECIST respectively as shown below:CR had2cases and3cases, PR had4cases and5cases, SD had10cases and3cases, PD had4cases and9cases; and the Clinical benefit rate (CBR) of this two group respectively was85%and55%, but P=0.176, t it had not statistically difference between the two.5months later, the results of experimental group and matched group were:(1) the narrowing rate of average maximum diameter line of target lesion respectively as shown below:(-9.41±53.67)%and (-16.13±74.28)%, P=0.745, it had not statistically difference between the two..(2) The intrahepatic metastasis or recurrence rate respectively was5%and45%, the data of control group was higher than the experimental group, P=0.008, it had statistically difference between the two.(3)The extrahepatic metastasis rate (EMR) respectively was20%and25%, P=1.00,it had not statistically difference between the two.(4) The assessment results of mRECIST respectively as shown below:CR had0cases and0cases, PR had3cases and2cases, SD had9cases and2cases, PD had8cases and15cases.The Clinical benefit rate (CBR) of this two group respectively was60%and21.1%,and P=0.022, it had statistically difference between the two.2. Survival analysis results from the study:The experimental group died16cases and4cases were truncated, median survival time (MST) was (13.000±1.649) months, half year survival rate was100%,1year survival rate was (58.9±11.2)%,1.5year survival rates was (11.8±7.8)%.Control group died16cases, and had4cases of the truncation, median survival time (MST) was (7.500±1.918) months, half year survival rate was (70.0±10.2)%,1year survival rate was (20.0±10.1)%,18months and24 months survival rate was0.The median survival time and survival rate of the experimental group were significantly higher than that of the control group, and P=0.018, these has statistically difference.Conclusion:1.The treatment of sorafenib combined with TACE is safety and effective for patients with middle and advanced primary hepatocellular carcinoma. It can reduce the recurrence rate, Intrahepatic Metastasis and extrahepatic metastasis rate. The longer of the treatment of sorafenib combined with TACE, the more obvious effective of synergism.2.The advantages of MSCT to evaluate the effective of the treatment of sorafenib combined with TACE is simple, noninvasive and ocular. It is not only to intuitive display the details of the anatomy for the region of interest, but also to quantitative analysis and to judge the survival and necrosis of the tumor. Tips the clinic to additional therapy immediately, in order to improve the curative effect and survival benefit. It is valuable for guiding the assessment of prognosis. |
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