Seki Hiroshi, Ozaki Toshirou, Shiina Makoto
Department of Radiology, Niigata Cancer Center Hospital, 2-15-3, Kawagishi-cho, Chuo-ku, Niigata 951-8566, Japan.
AJR Am J Roentgenol. 2008 Jan;190(1):111-20. doi: 10.2214/ajr.07.2038.
The objective of this study was to evaluate retrospectively correlations between catheter placement methods and treatment outcomes of patients treated with hepatic arterial infusion chemotherapy for unresectable liver metastases from colorectal cancer.
This study involved 135 patients with liver metastases from colorectal cancer who underwent intrahepatic chemotherapy using catheter-port systems. Complications, treatment discontinuation, hepatic progression, and survival of patients treated with each method were evaluated retrospectively using the Kaplan-Meier method. Conventional 5-French end-hole catheter placement (n = 10) was compared with three side-hole catheter placement methods: 5-French side-hole catheter placement with a fixed catheter tip (original fixed catheter tip method, n = 77); long tapered side-hole catheter placement using a fixed catheter tip method (modified fixed catheter tip method, n = 24); and long tapered side-hole catheter inserted distally in the hepatic artery (long tapered catheter placement method, n = 24).
The following treatment outcomes were significantly better for patients treated using the original or modified fixed catheter tip or long tapered catheter placement method than for those treated using the conventional method, respectively: hepatic arterial patency (1 year: 76.3%, 95.0%, and 94.4% vs 38.9%; p = 0.0014, 0.0007, and 0.0006), catheter stability (1 year: 96.7%, 95.5%, and 95.2% vs 42.9%; p < 0.0001, p = 0.0003, and p = 0.0009), time to treatment discontinuation (medians: 11.7, 14.4, and 12.4 vs 3.2 months; p < 0.0001, 0.0002, and 0.0019), time to hepatic progression (medians: 14.7, 15.7, and 15.8 vs 5.5 months; p = 0.0049, 0.0141, and 0.0004), and overall survival (medians: 21.1, 22.5, and 23.1 vs 13.1 months; p = 0.0146, 0.0036, and 0.0017).
Compared with the conventional method, side-hole catheter placement methods allowed long-term intrahepatic chemotherapy and resulted in improved survival.
本研究的目的是回顾性评估经肝动脉灌注化疗治疗不可切除的结直肠癌肝转移患者的导管置入方法与治疗效果之间的相关性。
本研究纳入了135例结直肠癌肝转移患者，这些患者接受了经导管-药盒系统的肝内化疗。采用Kaplan-Meier法回顾性评估每种方法治疗患者的并发症、治疗中断情况、肝脏进展情况和生存率。将传统的5法国端孔导管置入法（n = 10）与三种侧孔导管置入法进行比较：固定导管尖端的5法国侧孔导管置入法（原始固定导管尖端法，n = 77）；采用固定导管尖端法的长锥形侧孔导管置入法（改良固定导管尖端法，n = 24）；以及在肝动脉远端插入的长锥形侧孔导管（长锥形导管置入法，n = 24）。
采用原始或改良固定导管尖端或长锥形导管置入法治疗的患者，其以下治疗效果分别显著优于采用传统方法治疗的患者：肝动脉通畅率（1年：76.3%、95.0%和94.4% vs 38.9%；p = 0.0014、0.0007和0.0006）、导管稳定性（1年：96.7%、95.5%和95.2% vs 42.9%；p < 0.0001、p = 0.0003和p = 0.0009）、治疗中断时间（中位数：11.7、14.4和12.4 vs 3.2个月；p < 0.0001、0.0002和0.0019）、肝脏进展时间（中位数：14.7、15.7和15.8 vs 5.5个月；p = 0.0049、0.0141和0.0004）以及总生存期（中位数：21.1、22.5和23.1 vs 13.1个月；p = 0.0146、0.0036和0.0017）。
与传统方法相比，侧孔导管置入法可实现长期肝内化疗并提高生存率。
