Clinical Study Of TACE Combined With PMCT In The Treatment Of Advanced Hepatocellular Carcinoma

Objective: Through the comparison of the change of serum vascular endothelial growth factor(VEGF)level,alpha fetoprotein(AFP),hepatic functional reserve and lesions control rate and transfer rate before and after the treated with transcatheter arterial chemoembolization(TACE)combined with microwave ablation(PMCT)or treated with TACE only to explore the advantages of TACE combined with PMCT in the treatment of liver malignant tumors,and to explore the influence of PMCT on the immune function of patients with by comparing the changes of T lymphocyte subsets before and after treatment.Methods: In our department from January 2016 to January 2017 in accordance with the criteria for the study were a total of 78 cases of liver cancer patients,were randomly divided into experimental group(TACE and PMCT)and control group(the experimental group of 36 cases and 42 cases in the control group).Two groups patients were both treated with TACE and anti HBV therapy,and the experimental group was treated PMCT after TACE 5-7 days.Serum VEGF,AFP levels,liver reserve function(indocyanine green test,15 min retention rates)and T lymphocyte subsets were measured by 1 day before TACE or 5 days after TACE or PMCT.CT or MRI was performed to evaluate the tumour control rate(complete response,partial response,disease stabilization).Results:1.After the treatment of TACE,the serum VEGF concentration of control group was significantly higher than before treatment(P<0.05).After the treatment of TACE combined with PMCT,the serum VEGF concentration of experimental group was significantly lower than before treatment(P<0.05).2.30 cases of 42 patients in the control group with elevated levels of AFP preoperative,the levels of AFP were decreased in different degree after TACE,including 4 cases(4/30,13.3%)were normal,13 cases(12/30,40.0%)patients decreased more than 50%.25 cases of 36 patients in the experimental group 36 with elevated of AFP preoperative.After 1 month of treatment with PMCT we examined the level of AFP,which were decreased in different degree,including7 cases(7/25,28%)returned to normal,13 cases(13/25,52%)patients decreased more than 50%.After the treatment,the AFP rate of the experimental group was significantly better than the control group(P<0.05).3.After the treatment of TACE,the indocyanine green retention rate(ICG R15)of control group was significantly higher than before treatment(P<0.05).After the treatment of TACE combined with PMCT,the s ICG R15 of experimental group was significantly lower than before treatment,the difference was statistically significant.4.The CD3+T cells,CD4+T cells and CD4+/CD8+ ratio of patients in the control group after the treatment of TACE were significantly decreased,CD8+T cell levels were increased compared with before treatment(P<0.05);In the experimental group the CD3+T cells,CD4+T cells and CD4+ /CD8+ ratio were decreased,and the level of CD8+T cells were increased,but the difference was no statistically significant(P > 0.05).5.Lesions control rate comparison: according to the solid tumor measurement criteria of WHO to evaluate lesions control rate(complete response + partial response + stable disease),among which 7 cases of experimental group were complete response(CR),14 cases were partial response(PR),12 cases were disease stabilization(SD),3 cases were progressive disease(PD),the total control rate was 91.7%(33/36).The control group CR 4 cases,PR 13 cases,SD 14 cases,PD 11 cases,the total control rate was 73.8%(31/42).The control rate of the experimental group was significantly higher than that of the control group(P<0.05).6.The common complications of the two groups were nausea,vomiting,fever and pain,in addition to both of them occurred 1 case of serious complications.1 case in the control group(1/42,2.4%)occurred biloma,and 1case in the experimental group(1/36,2.8%)was bronchobiliary fistula.There is no statistically difference between the two groups.Conclusion:1.TACE treatment increase the damage of the liver function,but PMCT treatment has less effect on liver function.2.TACE treatment of hepatocellular carcinoma patients with a certain degree of damage to the cell immunity,but PMCT can improve cell immunity.3.TACE combined with PMCT for the treatment of liver cancer can complement each other.The combination of the two methods is safe,practical,effective and complementary advantages.It can improve the curative effect in patients with liver cancer,reduce metastasis and recurrence,so it is worthy of promotion.