【摘要】 目的探讨经导管动脉化疗栓塞术(TACE)对肝癌(HCC)基质金属蛋白酶-2(MMP-2)和基质金属蛋白酶-9(MMP-9)基因的表达以及对HCC患者预后的影响。资料与方法72例可切除HCC患者分为两组,一组行术前TACE然后行手术切除(A组,n=36),另一组直接行手术切除(B组,n=36)。对手术切除的标本行常规病理、免疫组织化学检查,比较两组切除标本中癌组织、癌旁组织中MMP-2和MMP-9基因的表达和分布。比较两组生存期,同时行Cox回归模型分析影响预后的因素。结果A组MMP-2表达呈强、弱和无表达分别为6例、12例和18例,而B组MMP-2表达呈强、弱和无表达分别为18例、3例和15例,两组比较有显著差异(χ2=11.67,P=0.03)。A组MMP-9表达呈强、弱和无表达分别为10例、15例和11例,而B组表达呈强、弱和无表达分别为18例、15例和3例,两组比较有显著差异(χ2=6.857,P=0.03)。A、B两组中位生存期分别为37.0个月和26.0个月,A组12、24、36个月生存率分别为94.4%、69.4%、50.9%,B组分别为88.6%%、60.0%、25.7%。两组差异有统计学意义(χ2=5.734,P=0.017)。多因素分析显示有意义的预后因素为:Child-pugh评分(P=0.001)、MMP-2表达(P=0.002)、MMP-9表达(P=0.007)、ALB(P=0.008)、门静脉癌栓(P=0.05)。结论TACE可以降低HCC组织MMP-2、MMP-9的表达,提示TACE有可能抑制HCC细胞的转移潜能。术前TACE有可能延长可切除HCC患者的生存期。更多还原

【Abstract】 Objective To investigate the effects of transcatheter arterial chemoembolization(TACE)on the expression of MMP-2、MMP-9 and prognosis in hepatocellular carcinoma(HCC). Materials and Methods Seventy-two patients with respectable HCC were divided into two groups. In group A,TACE was performed before tumor resection (n=36). In group B,the tumors were resected directly without preoperative TACE (n=36). The expression and distribution of nm23、TIMP-2 in tumor tissue and surrounding parenchyma of two groups and survival rates of two groups were compared. Cox proportion-hazard modeling was used to evaluate the relative importance of prognostic variables. Results The high,moderate and no expression of MMP-2 were observed in 6,12,18 cases in group A and 18,3 and 15 cases in group B. There were statistically differences between two groups (χ2=11.67,P=0.03). The high,moderate and no expression of MMP-9 were observed in 10,15,11 cases in Group A and 18,15,3 cases in group B. There were statistically differences between two groups (χ2=6.857,P=0.03). The median survival time in group A and B were 37.0 months and 26.0 months respectively. The cumulative survival rates at 12,24,36 months were 94.4%,69.4%,50.9% in group A,and 88.6%,60.0%,25.7% in group B. There was significant difference in survival rate between two groups (χ2=5.734,P=0.017). The influencing factors of prognosis were Child-Pugh scores (P=0.001),MMP-2 expression (P=0.002),MMP-9 expression (P=0.007),ALB level(P=0.008),tumor emboli in the portal vein (P=0.05). Conclusion TACE could decrease the expression of MMP-2,MMP-9 in tumor tissue. Therefore,the metastatic potentials of tumor cells might be prohibited by TACE. Pre-oprative TACE might improve survival rate in patients with resectable HCC.更多还原