DEB-TACE序贯微波消融术治疗大原发性肝癌患者临床疗效研究*

doi:10.3969/j.issn.1672-5069.2024.02.031

实用肝脏病杂志 ›› 2024, Vol. 27 ›› Issue (2): 283-286.doi: 10.3969/j.issn.1672-5069.2024.02.031

DEB-TACE序贯微波消融术治疗大原发性肝癌患者临床疗效研究^*

王秀香, 李海霞, 李辉, 王明月, 代树本, 于晓明

061001 河北省沧州市第三医院CT室(王秀香,李辉);放射科(李海霞);肝病一科(王明月);内镜室(代树本);河北大学附属医院肝病科(于晓明)

收稿日期:2023-10-20 出版日期:2024-02-10 发布日期:2024-03-08
通讯作者: 李海霞,E-mail:2211062598@qq.com
作者简介:王秀香,女,46岁,大学本科,副主任医师。研究方向:影像学诊断和实体肿瘤介入微创治疗。E-mail:kzj011@163.com
基金资助:
^*河北省自然科学基金青年基金资助项目(编号:H2021206248);沧州市科技计划自筹经费项目(编号:222106022)

Drug-eluting bead transcatheter arterial chemoembolization followed by microwave ablation in dealing with patients with large primary liver cancer

Wang Xiuxiang, Li Haixia, Li Hui, et al.

Department of Radiology, Third Hospital, Cangzhou 061001, Hebei Province, China

Received:2023-10-20 Online:2024-02-10 Published:2024-03-08

摘要/Abstract

摘要： 目的探讨采用载药栓塞微球经肝动脉化疗栓塞(DEB-TACE)序贯微波消融(MWA)术治疗原发性大肝癌(PLC)患者的临床疗效。方法 2018年5月～2021年5月我院收治的50例PLC患者, 纳入患者肝内肿瘤直径大于5 cm。采用随机数字表法将患者分为对照组25例和观察组25例, 分别接受常规TACE序贯MWA治疗或DEB-TACE序贯MWA术治疗。常规检测血清甲胎蛋白(AFP)和甲胎蛋白异质体(AFP-L3)。随访评估完全缓解(CR)、部分缓解(PR)、疾病稳定、疾病进展(PD), 统计客观缓解率(ORR)、疾病控制率(DCR)、无进展生存期(PFS)和总生存期(OS)。结果治疗后, 观察组CR、PR、SD、ORR和CDR分别为44.0%、48.0%、4.0%、92.0%和96.0%, 显著优于对照组(分别为36.0%、24.0%、16.0%、60.0%和76.0%, P<0.05); 治疗后观察组血清AFP和AFP-L3水平分别为(121.5±63.7) ng/mL和(7.1±0.2)%, 均显著低于对照组【分别为(434.9±68.5)ng/mL和(13.6±0.4)%, P<0.05】;治疗后随访(18.3±6.7)个月, 观察组病死率为24.0%, 与对照组的48.0%比, 差异无显著性统计学意义(x²=3.125, P=0.077);观察组和对照组中位PFS分别是8.3个月和5.3个月(t=3.172, P=0.075), 中位OS分别是14.5个月和9.4个月(t=2.432, P=0.082), 无显著性差异。结论采用DEB-TACE序贯MWA术治疗大肝癌患者可能临床近期疗效稍好, 但远期疗效还需要进一步研究。

关键词: 原发性肝癌, 载药栓塞微球, 经肝动脉化疗栓塞, 微波消融, 治疗

Abstract: Objective The purpose of this study was to investigate the clinical efficacy of drug-eluting bead transcatheter arterial chemoembolization (DEB-TACE) followed by microwave ablation (MWA) in dealing with patients with large primary liver cancer (PLC). Method 50 consecutive patients with large PLC were encountered in our hospital between May 2018 and May 2021, and were randomly divided into control and observation group, with 25 cases in each group. The patients in the control group was treated with conventional TACE and thereafter MWA, and the patients in the observation received DEB-TACE followed by MWA. All patients were followed-up and the efficacy was evaluated by complete remission (CR), partial remission (PR), stable disease (SD), progressive disease (PD), objective remission rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS). Results After treatment, the CR, PR, SD, ORR and CDR in the observation group were 44.0%, 48.0%, 4.0%, 92.0% and 96.0%, much superior to 36.0%, 24.0%, 16.0%, 60.0% and 76.0% (P<0.05) in the control; serum AFP and AFP-L3 levels in the observation were (121.5±63.7) ng/mL and (7.1±0.2)%, both much lower than in the control; after (18.3±6.7) month of follow-up after treatment, the fatality rate in the observation group was 24.0%, not significantly different compared to 48.0% in the control (x²=3.125, P=0.077); the median PFS in the observation and in the control were 8.3 mon and 5.3 mon (t=3.172, P=0.075), and the median OS in the two groups were 14.5 mon and 9.4 mon (t=2.432, P=0.082), not significantly different. Conclusion The short-term efficacy of DEB-TACE and MWA combination in treatment of patients with large PLC is definite, while the long-term efficacy should investigate further in the future.

Key words: Hepatoma, Drug-eluting bead transcatheter arterial chemoembolization, Microwave ablation, Therapy

王秀香, 李海霞, 李辉, 王明月, 代树本, 于晓明. DEB-TACE序贯微波消融术治疗大原发性肝癌患者临床疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 283-286.

Wang Xiuxiang, Li Haixia, Li Hui, et al.. Drug-eluting bead transcatheter arterial chemoembolization followed by microwave ablation in dealing with patients with large primary liver cancer[J]. Journal of Practical Hepatology, 2024, 27(2): 283-286.

参考文献

[1] 金志成,张齐,朱海东,等.原发性肝癌根治性切除术后辅助性TACE治疗的研究进展. 中华肝脏病杂志,2022,30(3):340-344.
[2] An C, Li WZ, Huang ZM, et al. Small single perivascular hepatocellular carcinoma: comparisons of radiofrequency ablation and microwave ablation by using propensity score analysis. Eur Radiol, 2021, 31(7):4764-4773.
[3] Ando Y, Kawaoka T, Suehiro Y,et al. Analysis of post-progression survival in patients with unresectable hepatocellular carcinoma treated with lenvatinib. Oncology, 2020, 98(11):1-11.
[4] 吕然,刘琛志. CalliSpheres载药微球TACE序贯MWA治疗单发直径＞5 cm原发性老年原发性肝癌的临床研究. 中华肿瘤防治杂志,2022,29(15):1136-1142.
[5] Zhang W, Yan Z. Efficacy and safety of apatinib combined with TACE in patients with hepatocellular carcinoma refractory to transcatheter arterial chemoembolization. J Clin Oncol, 2020, 38(15):155-157.
[6] Angelico M. TACE vs DEB-TACE: Who wins? Dig liver dis,2016,48(7):796-797.
[7] Shiani A, Narayanan S, Pena L, et al. The role of diagnosis and treatment of underlying liver disease for the prognosis of primary liver cancer. Cancer Control, 2017,24(3):1073274817729240.
[8] Ghosh A, Gupta V, Al Khalifah A, et al. Transradial versus transfemoral arterial access in DEB-TACE for hepatocellular carcinoma. J Clin Imaging Sci,2022,12(15):38.
[9] Shi Q, Liu J, Li T, et al. Comparison of DEB-TACE and cTACE for the initial treatment of unresectable hepatocellular carcinoma beyond up-to-seven criteria: a single-center propensity score matching analysis. Clin Res Hepatol Gas,2022,46(5):101893.
[10] Nault JC, Cheng AL, Sangro B,et al. Milestones in the pathogenesis and management of primary liver cancer. J Hepatol, 2020, 72(2):209-214.
[11] Schobert IT, Savic LJ, Chapiro J,et al. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictors of tumor response in hepatocellular carcinoma after DEB-TACE. Eur Radiol, 2020, 30(2):5663-5673.
[12] 方世记,郑丽云,程适妙,等. TACE联合RFA治疗中晚期PLC后早期复发相关危险因素研究. 中华介入放射学电子杂志,2019,7(2):106-110.
[13] Bargellini I, Lorenzoni V, Lorenzoni G, et al. Duration of response after DEB-TACE compared to lipiodol-TACE in HCC-nave patients: a propensity score matching analysis. Eur Radiol, 2021, 31(9822):7512-7522.
[14] Ayyub J, Dabhi KN, Gohil NV, et al. Evaluation of the safety and efficacy of conventional transarterial chemoembolization (cTACE) and drug-eluting bead (DEB)-TACE in the management of unresectable hepatocellularcarcinoma: a systematic review. Cureus,2023,15(7):e41943.
[15] Lencioni R, Llovet JM, Han G, et al. Sorafenib or placebo plus TACE with doxorubicin-eluting beads for intermediate stage HCC: The SPACE trial. J Hepatol,2016,64(5):1090-1098.
[16] 卞锦花, 达婷, 罗建梅,等. 超声引导下经皮MWA联合肝动脉化疗栓塞治疗PLC的疗效观察. 中华实用诊断与治疗杂志, 2020, 34(5):83-86.
[17] Yamao T, Yamashita Y I, Imai K, et al. Clinical significance of preoperative hepatocellular carcinoma with high lens culinaris agglutinin-reactive fraction of alpha-fetoprotein, aut low alpha-fetoprotein. J Anticancer Res, 2019, 39(2):883-889.
[18] 丁海斌,张欣,李雅,等. TACE序贯MWA联合索拉非尼治疗大肝细胞癌患者临床疗效研究. 实用肝脏病杂志,2023,26(1):108-111.
[19] Wang J, Xue Y, Liu R, et al. DEB-TACE with irinotecan versus C-TACE for unresectable intrahepatic cholangiocarcinoma: a prospective clinical study J. Front Bioeng Biotech,2023,10(12):1112500.
[20] Li N, Chen J. Efficacy and safety of drug-eluting bead transarterial chemoembolization (DEB-TACE) plus apatinib versus DEB-TACE alone in treating huge hepatocellular carcinoma patients. Ir J Med Sci,2022,191(6):2611-2617.

DEB-TACE序贯微波消融术治疗大原发性肝癌患者临床疗效研究^*

Drug-eluting bead transcatheter arterial chemoembolization followed by microwave ablation in dealing with patients with large primary liver cancer

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