冷冻消融与微波消融治疗对肝细胞癌患者临床指标和细胞因子的影响

向姣; 贾晓东; 卢姗姗; 吴大为; 张婷; 董金珂; 黄家干; 李茵茵; 杨斌; 徐勇; 董政; 路营; 曾珍; 陆荫英

doi:10.3969/j.issn.1001-5256.2019.08.016

冷冻消融与微波消融治疗对肝细胞癌患者临床指标和细胞因子的影响

DOI: 10.3969/j.issn.1001-5256.2019.08.016

贵州医科大学附属医院感染科
解放军总医院第五医学中心肝脏肿瘤诊疗与研究中心

基金项目:

“精准医学研究”重点专项计划(2017YFC0908400)；国家科技重大专项课题(2018ZX10723204,2018ZX10302205)；

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中图分类号: R735.7
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出版历程
- 收稿日期: 2019-05-29
- 出版日期: 2019-08-20

Effect of cryoablation versus microwave ablation on clinical indices and cytokines in patients with hepatocellular carcinoma

Department of Infectious Diseases, The Affiliated Hospital of Guizhou Medical University

Research funding:

摘要

摘要:
目的探讨冷冻消融和微波消融治疗前后肝细胞癌（HCC）患者外周血临床指标和细胞因子的变化及临床意义。方法收集2018年6月-12月于解放军总医院第五医学中心治疗的62例HCC患者的临床资料,按照治疗方案分为:冷冻消融治疗组（n=30）和微波消融治疗组（n=32）。分别测定两组患者手术前1周及手术后2 d的血常规（WBC、Hb、PLT）、肝功能（ALT、AST、TBil、ALb）、凝血功能（INR）和外周血细胞因子[IL-2、TNFα、IL-6、IL-8、肝细胞生长因子（HGF）、血管内皮生长因子（VEGF） A]。计数资料组间比较采用χ2检验或Fisher精确检验;计量资料两组间比较采用t检验或Mann-Whithey U检验。结果与术前相比,两组患者术后WBC均升高、PLT均降低,差异均有统计学意义（冷冻消融组:t值分别为-7. 480、-4. 280;微波消融组:t值分别为-5. 735、-3. 075,P值均<0. 001）,其中冷冻消融组PLT变化更显著（Z=-4. 457,P <0. 001）;两组患者术后ALT、AST、TBil水平均升高且差异均有统计学意义（冷冻...
- 癌,肝细胞 /
- 消融技术 /
- 细胞因子类
Abstract:
Objective To investigate the changes in clinical indices and cytokines in peripheral blood after cryoablation or microwave ablation in patients with hepatocellular carcinoma (HCC) and related clinical significance. Methods A total of 62 patients with HCC who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from June to December, 2018, were enrolled, and according to the treatment regimen, these patients were divided into cryoablation group with 30 patients and microwave ablation group with 32 patients. The two groups were compared in terms of routine blood test results [white blood cell count (WBC) , hemoglobin, and platelet count (PLT) ], liver function [alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , total bilirubin (TBil) , and albumin], coagulation function (international normalized ratio) , and peripheral blood cytokines [interleukin-2, tumor necrosis factor-α, interleukin-6 (IL-6) , interleukin-8, hepatocyte growth factor (HGF) , and vascular endothelial growth factor A (VEGFA) ]at 1 week before surgery and on day 2 after surgery. The chi-square test and the Fisher's exact test were used for comparison of categorical data between groups, and the t-test and the Mann-Whitney U test were used for comparison of continuous data between groups. Results Both groups had a significant increase in WBC and a significant reduction in PLT after surgery (cryoablation group: t =-7. 480 and-4. 280, both P < 0. 001; microwave ablation group:t =-5. 735 and-3. 075, both P < 0. 001) , and the cryoablation group had a significantly greater reduction in PLT than the microwave ablation group (Z =-4. 457, P <0. 001) . Both groups had significant increases in ALT, AST, and TBil after surgery (cryoablation group: Z =-4. 457, -4. 445, and-4. 229, all P < 0. 001; microwave ablation group: Z =-3. 617, -4. 703, and-4. 228, all P < 0. 001) , and the cryoab-lation group had significantly greater increases in ALT and AST than the microwave ablation group (Z =-3. 411 and-3. 829, both P <0. 001) . The cryoablation group had significant increases in IL-6, HGF, and VEGFA after surgery (Z =-4. 076, -4. 311, and-3. 123, all P < 0. 05) , with significantly greater increases than the microwave ablation group (Z =-2. 735, -2. 578, and-2. 201, all P <0. 05) . Conclusion Compared with microwave ablation, cryoablation can induce a higher level of acute inflammatory response within the short term after surgery, which may lead to higher rates of postoperative complications and tumor recurrence.
- carcinoma, hepatocellular /
- ablation techniques /
- cytokines

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参考文献(33)

[1] SARASWAT VA, PANDY G, SHETTY S. Treatment algorithms for managing hepatocellular carcinoma[J]. J Clin Exp Hepatol, 2014, 4 (Suppl 3) :80-89.

[2] HUANG J, YAN L, CHENG Z, et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria[J]. Ann Surg, 2010, 252 (6) :903-912.

[3] LEE DH, LEE JM, LEE JY, et al. Radiofrequency ablation of hepatocellular carcinoma as first-line treatment:Long-term results and prognostic factors in 162 patients with cirrhosis[J]. Radiology, 2014, 270 (3) :900-909.

[4] LI FM, CHEN FZ, LI WG. Progress in ablation therapy of liver cancer[J]. World Chin J Dig, 2017, 25 (27) :2427-2432. (in Chinese) 李凤鸣, 陈福真, 李文岗.肝癌消融治疗的进展[J].世界华人消化杂志, 2017, 25 (27) :2427-2432.

[5] CUCCHETTI A, PISCAGLIA F, CESCON M, et al. Systematic review of surgical resection vs radiofrequency ablation for hepatocellular carcinoma[J]. World J Gastroenterol, 2014, 270 (3) :4106-4118.

[6] LAHAT E, ESHKENAZY R, ZENDEL A, et al. Complications after percutaneous ablation of liver tumors:A systematic review[J]. Hepatobiliary Surg Nutr, 2014, 3 (5) :317-323.

[7] PULJK R, RUARUS A, SCHEFFER H, et al. Percutaneous liver tumor ablation:Image guidance, endpoint assessment, and quality control[J]. Can Assoc Radiol J, 2018, 69 (1) :51-62.

[8] VOGL T, NOURELDIN N, HANMMERSTINGL R, et al. Microwave abla-tion (MWA) :Basics, technique and results in primary and meta-static liver neoplasms-review article[J]. Rofo, 2017, 189 (11) :1055-1066.

[9] European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASLEORTC clinical practice guidelines:Management of hepatocellular carcinoma[J]. J Hepatol, 2012, 56 (4) :908-943.

[10] WELLS SA, HINSHAW JL, LUBNER MG, et al. Liver ablation:Best practice[J]. Radiol Clin N Am, 2015, 53 (5) :933-971.

[11] LIVRAGHI T, MELONI F, ZANUS L. Complications of microwave ablation for liver tumors:Results of a multicenter study[J]. Cardiovasc Intervent Radiol, 2012, 35 (4) :868-874.

[12] CHINNARATHA MA, CHUANG MY, CHUANG MY, et al. Percutaneous thermal ablation for primary hepatocellular carcinoma:A systematic review and meta-analysis[J]. J Gastroenterol Hepatol, 2016, 31 (2) :294-301.

[13] FACCINRUSSO A, DIMASO M, MUSCATIELLO M, et al. Microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma:A systematic review and meta-analysis[J]. Int J Hyperthermia, 2016, 32 (3) :339-344.

[14] SONG KD. Percutaneous cryoablation for hepatocellular carcinoma[J]. Clin Mol Hepatol, 2016, 22 (4) :509-515.

[15] HUANG YZ, ZHOU SC, ZHOU H, et al. Radiofrequency ablation versus cryosurgery ablation for hepatocellular carcinoma:A meta-analysis[J]. Hepatogastroenterology, 2013, 60 (125) :1131-1135.

[16] JANSEN MC, VAN HR, SCHOOTS LG, et al. Cryoablation induces greater inflammatory and coagulative responses than radiofrequency ablation or laser induced thermotherapy in a rat liver model[J]. Surgery, 2010, 147 (5) :686-695.

[17] OSADA S, LMAI H, TOMITA H, et al. Serum cytokine levels in response to hepatic cryoablation[J]. J Surg Oncol, 2007, 95 (6) :491-498.

[18] ZHOU HT, NIU LZ, ZHOU L, et al. The change of partial biochemical parameters and pro-inflammatory cytokines of hepatic carcinoma patients treated with cryoablation therapy[J].Chin J Gastroenterol Hepatol, 2009, 18 (2) :110-112. (in Chinese) 周红桃, 牛立志, 周亮, 等.肝癌患者冷消融后部分生化指标和前炎症因子的变化[J].胃肠病学和肝病学杂志, 2009, 18 (2) :110-112.

[19] YANG Y, WANG Y, WANG Y, et al. Outcomes of ultrasound-guided percutaneous argon-helium cryoablation of hepatocellular carcinoma[J]. J Hepatobiliary Pancreat Sci, 2012, 19 (6) :674-684.

[20] HU K. Advances in clinical application of cryoablation therapy for hepatocellular carcinoma and metastatic liver tumor[J]. J Clin Gasstroenterol, 2014, 48 (10) :830-836.

[21] ZHU Y, LI JY, WANG LF, et al. Progress in ablation therapy of liver cancer[J]. Chin J Gen Pract, 2013, 11 (2) :183-184. (in Chinese) 朱云, 李建宇, 王立福, 等.射频消融、氩氦刀冷冻治疗肝癌对肝功能影响的比较[J].中华全科医学, 2013, 11 (2) :183-184.

[22] SEIFERT JK, FRANCE MP, ZHAO J, et al. Large volume hepatic freezing:Association with significant release of the cytokines interleukin-6 and tumor necrosis factor a in a rat model[J]. World J Surg, 2002, 26 (11) :1333-1341.

[23] WANG P, BA ZF, CHAUDRY I. Key role of increased gene expression and release of proinflammatory cytokines tumor necrosis factor and inter leukin-6[J]. Arch Surg, 1997, 132 (4) :364-369.

[24] SCHIRMACHER P, GEERTS A, PIETRANGELO A, et al. Hepatocyte growth factor/hepatopoietin A is expressed in fat-storing cells from rat liver but not myofibroblast-like cells derived from fatstoring cells[J]. Hepatology, 1992, 15 (1) :5-11.

[25] MAHER JJ. Cell-specific expression of hepatocyte growth factor in liver:Upregulation in sinusoidal endothelial cells after carbon tetrachloride[J]. J Clin Invest, 1993, 91 (5) :2244-2252.

[26] ZHU M, PADDOCK GV. Expression of the hepatocyte growth factor-like protein gene in human hepatocellular carcinoma and interleukin-6-induced increased expression in hepatoma cells[J]. Biochim Biophys Acta, 1999, 1449 (1) :63-72.

[27] MATSUMOMO K, NAKAMURA T, SAKAI K, et al. Hepatocyte growth factor and met in tumor biology and therapeutic approach with NK4[J]. Proteomics, 2008, 8 (16) :3360-3370.

[28] WU FS, ZHENG SS, WU LJ, et al. Study on the prognostic value of hepatocyte growth factor and c-met for patients with hepatocellular carcinoma[J]. Chin J Surg, 2006, 44 (9) :603-608. (in Chinese) 吴福生, 郑树森, 吴灵娇, 等.肝细胞生长因子及其受体c-met在肝细胞癌中的表达与预后价值[J].中华外科杂志, 2006, 44 (9) :603-608.

[29] LAU EY, LO J, CHENG BY, et al. Cancer-associated fibroblasts regulate tumor-initiating cell plasticity in hepatocellular carcinoma through c-Met/FRA1/HEY1 signaling[J]. Cell Rep, 2016, 15 (6) :1175-1189.

[30] KYZAS PA, CUNHA IW, IOANNIDIS JP. Prognostic significance of vascular endothelial growth factor immunohistochemical expression in head and neck squamous cell carcinoma:A meta analysis[J]. Clin Cancer Res, 2005, 11 (4) :1434-1440.

[31] PRIES R, WOLLENBERG B. Cytokines in head and neck cancer[J]. Cytokine Growth Factor Rev, 2006, 17 (3) :141-146.

[32] YANG X, ZHANG XF, LU X, et al. MicroRNA26a suppresses angiogenesis in human hepatocellular carcinoma by targeting hepatocyte growth factorcMet pathway[J]. Hepatology, 2014, 59 (5) :18741885.

[33] KONG J, PAN B, KE S, et al. Insufficient radiofrequency ablation promotes angiogenesis of residual hepatocellular carcinoma via HIF1α/VEGFA[J]. PLo S One, 2012, 7 (5) :260-266.

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