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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。
Objective To investigate the effect of transcatheter arterial chemoembolization (TACE) on the expression of matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) in hepatocellular carcinoma (HCC) and its effect on the prognosis of HCC patients. Materials and Methods Seventy-two resectable HCC patients were divided into two groups. One group underwent preoperative TACE followed by surgical resection (group A, n=36) and the other group underwent surgical resection (group B, n=36). Routine pathological and immunohistochemical examinations were performed on surgically resected specimens to compare the expression and distribution of MMP-2 and MMP-9 genes in cancer tissue and paracancerous tissues between the two groups. The survival time of the two groups was compared. The Cox regression model was used to analyze the factors affecting the prognosis. Results In group A, the expression of MMP-2 was strong, weak, and non-expressed in 6 cases, 12 cases, and 18 cases respectively. In group B, the expression of MMP-2 was strong, weak, and non-expressive in 18 cases, 3 cases, and 15 cases, respectively. There was a significant difference between the two groups (χ2=11.67, P=0.03). In group A, the expression of MMP-9 was strong, weak, and non-expressive in 10 cases, 15 cases, and 11 cases respectively, while in group B the expression was strong, weak, and non-expressive in 18 cases, 15 cases, and 3 cases respectively. Significant difference (χ2=6.857, P=0.03). The median survival time for A and B groups was 37.0 months and 26.0 months, respectively. The survival rates at 12, 24, and 36 months in group A were 94.4%, 69.4%, and 50.9%, respectively. In group B, 88.6% and 60.0 respectively. %, 25.7%. There was a statistically significant difference between the two groups (χ2=5.734, P=0.017). Multivariate analysis showed that significant prognostic factors were Child-pugh score (P=0.001), MMP-2 expression (P=0.002), MMP-9 expression (P=0.007), ALB (P=0.008), and portal vein cancer. Suppository (P=0.05). Conclusion TACE can reduce the expression of MMP-2 and MMP-9 in HCC tissues, suggesting that TACE may inhibit the metastatic potential of HCC cells. Preoperative TACE may prolong the survival of resectable HCC patients.