Bloomston Mark, Al-Saif Osama, Klemanski Dori, Pinzone Joseph J, Martin Edward W, Palmer Bryan, Guy Gregory, Khabiri Hooman, Ellison E Christopher, Shah Manisha H
Department of Surgery, James Cancer Hospital and Solove Research Institute, Ohio State University Medical Center, Columbus, OH, 43210, USA.
J Gastrointest Surg. 2007 Mar;11(3):264-71. doi: 10.1007/s11605-007-0089-z.
Hepatic artery chemoembolization (HACE) is a treatment option in the management of metastatic carcinoid. We reviewed our experience to identify potential factors that influence survival.
The records of 122 patients with metastatic carcinoid tumor undergoing HACE were reviewed. Log-rank analysis and Cox proportional hazards were applied to identify factors predictive of decreased survival.
Median follow-up after HACE was 21.5 months. Complications occurred in 23% with periprocedural mortality of 5%. Radiographic tumor regression was seen in 82%, with stabilization of disease in 12%. Median duration of CT response was 19 months. Improvement in symptoms occurred in 92% for median duration of 13 months. HACE resulted in complete normalization of serum pancreastatin in 14%, with greater than 20% reduction in another 66%. Median overall survival was 33.3 months after HACE. Only pancreastatin level > or =5,000 pg/ml was associated with decreased survival by multivariate analysis.
HACE offers symptom palliation and long-term survival in patients with incurable carcinoid metastases. Although safe, it should be approached cautiously in patients with significant tumor burden as evidenced by pancreastatin levels > or =5,000 pg/ml. We do not recommend whole-liver embolization in these patients but prefer a staged approach to each lobe of the liver.
肝动脉化疗栓塞术（HACE）是转移性类癌治疗的一种选择。我们回顾了我们的经验以确定影响生存的潜在因素。
回顾了122例接受HACE治疗的转移性类癌患者的记录。应用对数秩分析和Cox比例风险模型来确定预测生存降低的因素。
HACE后的中位随访时间为21.5个月。23%的患者出现并发症，围手术期死亡率为5%。82%的患者影像学显示肿瘤缩小，12%的患者病情稳定。CT反应的中位持续时间为19个月。92%的患者症状改善，中位持续时间为13个月。HACE使14%的患者血清胰抑素完全恢复正常，另外66%的患者血清胰抑素降低超过20%。HACE后中位总生存期为33.3个月。多因素分析显示只有胰抑素水平≥5000 pg/ml与生存降低相关。
HACE为无法治愈的类癌转移患者提供症状缓解和长期生存。虽然HACE安全，但对于胰抑素水平≥5000 pg/ml所证明的肿瘤负荷较大的患者应谨慎使用。我们不建议对这些患者进行全肝栓塞，而是倾向于对肝脏的每个叶采用分期治疗方法。
