HIFU消融联合化疗治疗中晚期肝母细胞瘤小儿5年随访研究*

doi:10.3969/j.issn.1672-5069.2023.06.036

摘要/Abstract

摘要： 目的观察采用高强度聚焦超声(HIFU)消融联合化疗治疗中晚期肝母细胞瘤(HB)患儿的5年随访疗效。方法 2013年8月～2017年2月我院诊治的41例中晚期HB患儿,其中18例对照组患儿接受CAO化疗方案治疗,另23例在化疗治疗结束后,行HIFU消融治疗。随访5年。使用流式细胞仪检测外周血CD3⁺、CD4⁺、CD8⁺细胞百分比。结果观察组有效率和疾病控制率分别为65.2%和87.0%,显著高于对照组的33.3%和55.6%(P＜0.05);治疗后,观察组外周血CD4⁺细胞百分比和CD4⁺/CD8⁺细胞比值分别为(42.5±3.9)%和(1.6±0.4),均显著高于对照组【分别为(39.4±3.5)%和(1.3±0.3),P＜0.05】,而CD3⁺和CD8⁺细胞百分比分别为(55.4±5.2)%和(26.1±2.4)%,均显著低于对照组【分别为(60.1±5.9)%和(30.0±2.8)%,P＜0.05】;观察组不良反应发生率为34.8%,与对照组的33.3%比,无显著性差异(P＞0.05);观察组1 a、3 a和5 a生存率分别为100.0%(21/21)、71.4%(15/21)和28.6%(6/21),对照组分别为100.0%(17/17)、41.2%(7/17)和11.8%(2/17),两组无显著性差异(Log-Rank=3.160,P=0.075)。结论采用HIFU消融联合化疗治疗HB患儿可以取得一定的临床效果,但进行消融治疗的益处还需要研究。

关键词: 肝母细胞瘤, 化疗, 高强度聚焦超声消融, 治疗, 小儿

Abstract: Objective The aim of this study was to observe the long-term efficacy of high intensity focused ultrasound (HIFU) ablation and chemotherapy in the treatment of children with advanced hepatoblastoma (HB). Methods 41 children with advanced HB were encountered in our hospital between August 2013 and February 2017, and were divided into control (n=18) and observation group (n=23), receiving CAO chemotherapy, or HIFU ablation after chemotherapy. All the children were followed-up for five years. The percentages of peripheral blood CD3⁺, CD4⁺, CD8⁺ cells were determined by FCM. Results The effective rate and disease control rate in the observation group were 65.2% and 87.0%, both much higher than 33.3% and 55.6%(P＜0.05) in the control; 3 months after treatment, the percentages of CD4⁺ cells and the ratio of CD4⁺/CD8⁺ cells in the observation group were (42.5±3.9)% and (1.6±0.4), both significantly higher than [(39.4±3.5)% and (1.3±0.3), respectively, P＜0.05], while the percentages of CD3⁺ cells and CD8⁺ cells were (55.4±5.2)% and (26.1±2.4)%, both significantly lower than [(60.1±5.9)% and (30.0±2.8)%, respectively, P＜0.05] in the control group; the incidence of untoward effect in the observation group was 34.8%, not significantly different compared to 33.3% in the control (P＞0.05); the one-year, three-year and five-year survival rates in the observation group were 100.0%(21/21), 71.4%(15/21) and 28.6%(6/21) as two lost visit, also not significantly different as compared to 100.0%(17/17), 41.2%(7/17) and 11.8%(2/17) as one lost visit (Log-Rank=3.160, P=0.075) in the control group. Conclusion The HIFU ablation and chemotherapy has a clinical efficacy in the treatment of children with HB, which should be carefully investigated in the future.

Key words: Hepatoblastoma, Chemotherapy, High intensity focused ultrasound ablation, Therapy, Children

青秀, 周沙, 刘斌. HIFU消融联合化疗治疗中晚期肝母细胞瘤小儿5年随访研究^*[J]. 实用肝脏病杂志, 2023, 26(6): 911-914.

Qing Xiu, Zhou Sha, Liu Bin. A five-year follow-up observation of children with advanced hepatoblastoma after HIFU ablation and chemotherapy[J]. Journal of Practical Hepatology, 2023, 26(6): 911-914.

参考文献

[1] Zhang F, Zhang CM, Li S, et al. Low dosage of arsenic trioxide inhibits vasculogenic mimicry in hepatoblastoma without cell apoptosis. Mol Med Rep, 2018, 17(1):1573-1582.
[2] Halliburton G, Murad HY, Kala M, et al. In vivo investigation of high-intensity focused ultrasound combined with thermally triggered chemotherapy for liver cancer treatment. J Acoust Soc Am, 2017, 142(4):2720-2721.
[3] Viganò L, Capussotti L, Rosa GD, et al. Liver resection for colorectal metastases after chemotherapy: Impact of chemotherapy-related liver injuries, pathological tumor response, and micrometastases on long-term survival. Ann Surg, 2013, 258(5):731-742.
[4] Hiyama E, Hishiki T, Watanabe K, et al. Resectability and tumor response after preoperative chemotherapy in hepatoblastoma treated by the Japanese study group for pediatric liver tumor (jplt)-2 protocol. J Pediatr Surg, 2016, 51(12):2053-2057.
[5] Dason S, Wong NC, Allard CB, et al. High-intensity focused ultrasound (HIFU) as salvage therapy for radio-recurrent prostate cancer: Predictors of disease response. Int Braz J Urol, 2018, 44(2):248-257.
[6] Wang Y, Wang ZB, Xu YH. Efficacy, efficiency, and safety of magnetic resonance-guided high-intensity focused ultrasound for ablation of uterine fibroids: Comparison with ultrasound-guided method. Korean J Radiol, 2018, 19(4):724-732.
[7] Trimboli P, Bini F, Marinozzi F, et al. High-intensity focused ultrasound (HIFU) therapy for benign thyroid nodules without anesthesia or sedation. Endocrine, 2018, 61(2):210-215.
[8] 黄仕颖, 梁爽, 魏杨辉,等. CAO方案化疗联合高频聚焦超声消融治疗Ⅲ/Ⅳ期肝母细胞瘤患儿疗效分析. 实用肝脏病杂志, 2019, 22(4):569-572.
[9] Beck A, Trippel F, Wagner A, et al. Overexpression of uhrf1 promotes silencing of tumor suppressor genes and predicts outcome in hepatoblastoma. Clin Epigenetics, 2018, 10(1):27-28.
[10] Vitolo U, Trněn M, Belada D, et al. Obinutuzumab or rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone in previously untreated diffuse large B-cell lymphoma. J Clin Oncol, 2017, 35(31):3529-3537.
[11] Winter S, Fasola S, Brisse H, et al. Relapse after localized rhabdomyosarcoma: Evaluation of the efficacy of second-line chemotherapy. Pediatr Blood Cancer, 2015, 62(11):1935-1941.
[12] Montoto S, Camós M, Guillermo AL, et al. Hybrid chemotherapy consisting of cyclophosphamide, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (c-mopp/abv) as first-line treatment for patients with advanced hodgkin disease. Cancer, 2015, 88(9):2142-2148.
[13] Nair R, Ramakrishnan G, Nair NN, et al. A randomized comparison of the efficacy and toxicity of epirubicin and doxorubicin in the treatment of patients with non-Hodgkin's lymphoma. Cancer, 2015, 82(11):2282-2288.
[14] Mascarenhas L, Felgenhauer JL, Bond MC, et al. Pilot study of adding vincristine, topotecan, and cyclophosphamide to interval‐compressed chemotherapy in newly diagnosed patients with localized ewing sarcoma: A report from the children's oncology group. Pediatr Blood Cancer, 2016, 63(3):493-498.
[15] Raj RR, Spady KK, Hoffman R I, et al. Hepatoblastoma: A need for cell lines and tissue banks to develop targeted drug therapies. Front Pediatr, 2016, 4(4):22-22.
[16] 陈杰, 吉芳, 雷钟,等. 右美托咪定对恶性肿瘤患者术后细胞免疫功能的影响:meta分析. 中华麻醉学杂志, 2018, 38(4):454-457.
[17] 翟志伟, 王振军, 张坤宁,等. 外周血T淋巴细胞亚群变化与直肠癌患者新辅助放化疗效果的关系. 中华普通外科杂志, 2020, 35(5):397-400.
[18] 周晓波. 化疗联合高强度聚焦超声消融术治疗儿童不可切除的肝母细胞瘤. 中华实用儿科临床杂志, 2016, 31(14):1107-1108.
[19] 陈加平, 郭春宝, 张明满. 儿童Ⅲ,Ⅳ期肝母细胞瘤化疗联合高强度聚焦超声消融术与化疗的疗效对比. 中华小儿外科杂志, 2015, 36(1):26-31.
[20] Lovvorn HN, Ayers D, Zhao Z, et al. Defining hepatoblastoma responsiveness to induction therapy as measured by tumor volume and serum α-fetoprotein kinetics. J Pediatr Surg, 2010, 45(1):121-129.

HIFU消融联合化疗治疗中晚期肝母细胞瘤小儿5年随访研究^*

A five-year follow-up observation of children with advanced hepatoblastoma after HIFU ablation and chemotherapy

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