A Clinical Application Research Of Recombinant Human Endostatin Combined With TACE In Advanced Hepatocellular Carcinoma

Objective To investigate the clinical application of the serum levels of free VEGF and CTPI in evaluating the therapeutic effects of recombinant human endostatin combined with TACE in patients with advanced hepatocellular carcinoma.And evaluate the clinical efficacy of recombinant human endostatin combined with TACE in patients with advanced hepatocellular carcinoma.Methods 52 patients with advanced hepatocellular carcinoma were randomly divided into two groups,group A 26 patients treatmented with simple TACE,Group B 26 patients treatmented with recombinant human endostatin combined with TACE.The serum levels of free VEGF were measured by ELISA before and 1,2,3 weeks after treatment.Simultaneously,CT perfusion imaging was performed 1 day before TACE therapy and 1 month after TACE therapy.The perfusion parameters(BF,BV,MTT)in tumorous parenchyma were measured in all hepatic lesions.And all the patients to maintain a period of 20 months follow-up.Results 1.The serum levels of free VEGF:Preoperatively,no significant difference was found in the expression of serum free VEGF between the two groups(t = 0.176 p=0.633).Postoperatively,the expression of serum free VEGF in group A was gradually increased,reached a peak 1 week after TACE therapy,then showed a downward trend,and the lowest 3 weeks after TACE therapy.Group B showed a slow descending trend,the lowest 2 weeks after TACE therapy,then slowly increased.Postoperatively the serum levels of free VEGF in group A were significantly higher than those in group B at each time point(F = 35.536 P<0.05).2.CT perfusion parameters:Before treatment,no significant difference was found in CT perfusion parameters(BF,BV,MTT)between the two groups(t = 0.349 p=0.783;t = 0.657 p = 0.543;t = 0.638 p = 0.583).After treatment,the difference of CT perfusion parameters(BF,BV,MTT)between the two groups were statistically significant(t = 6.743 p = 0.000;t = 4.837 p = 0.000;t = 5.518 p =0.000).Postoperatively,the perfusion parameters BF in the two groups were lower than those preoperative,the difference was statistically significant(t = 4.332 p =0.014;t = 12.236 p = 0.000);BV were lower than preoperative,the difference in group A was statistically significant(t = 9.372 p = 0.000),and there was no statistically significant difference in group B(t = 1.956 p = 0.075);MTT were longer than preoperative,the group A show no significant difference(t = 0.329 p = 0.718),and in group B the difference was significantly(t = 7.519 p = 0.000).3.Survival analysis:The median survival time of the two groups was(10.63 ±1.73)months and(13.16 ± 1.95)months respectively;and the difference of the overall survival rate of the two groups was statistically significant(p<0.05).Conclusion Recombinant human endostatin combined with TACE can effectively inhibit the expression of VEGF in tumor tissue,reduce the blood flow of tumor and inhibit tumor angiogenesis.Compared with TACE alone,recombinant human endostatin combined with TACE can prolong the median survival time of patients with advanced liver cancer and improve the overall survival rate.