Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, CA, USA.
HPB (Oxford). 2008;10(6):396-404. doi: 10.1080/13651820802356564.
Transcatheter arterial embolization (TAE) and chemoembolization (TACE) are increasingly used to treat unresectable primary and metastatic liver tumors. The purpose of this study was to determine the objective response to TAE and TACE in unresectable hepatic malignancies and to identify clinicopathologic predictors of response.
Seventy-nine consecutive patients who underwent 119 TAE/TACE procedures between 1998 and 2006 were reviewed. The change in maximal diameter of 121 evaluable lesions in 56 patients was calculated from pre and post-procedure imaging. Response rates were determined using Response Evaluation Criteria in Solid Tumors (RECIST) guidelines. The Kaplan-Meier method was used to compare survival in responders vs. non-responders and in primary vs. metastatic histologies.
TAE and TACE resulted in a mean decrease in lesion size of 10.3%+/-1.9% (p<0.001). TACE (vs. TAE) and carcinoid tumors were associated with a greater response (p<0.05). Lesion response was not predicted by pre-treatment size, vascularity, or histology. The RECIST partial response (PR) rate was 12.3% and all partial responders were in the TACE group. Neuroendocrine tumors, and specifically carcinoid lesions, had a significantly greater PR rate (p<0.05). Overall survival, however, was not associated with histology or radiologic response.
TAE and TACE produce a significant objective treatment response by RECIST criteria. Response is greatest in neuroendocrine tumors and is independent of vascularity and lesion size. TACE appears to be superior to TAE. Although an association of response with improved survival was not demonstrated, large cohort studies are necessary to further define this relationship.
经导管动脉栓塞术（TAE）和化疗栓塞术（TACE）越来越多地用于治疗不可切除的原发性和转移性肝肿瘤。本研究旨在确定不可切除的肝恶性肿瘤 TAE 和 TACE 的客观反应，并确定反应的临床病理预测因子。
回顾了 1998 年至 2006 年间连续 79 例接受 119 次 TAE/TACE 治疗的患者。对 56 例患者的 121 个可评估病变的最大直径在术前和术后影像学上的变化进行了计算。使用实体瘤反应评估标准（RECIST）指南确定反应率。Kaplan-Meier 法比较了反应者与无反应者、原发性与转移性组织学之间的生存情况。
TAE 和 TACE 导致病变大小平均减少 10.3%+/-1.9%（p<0.001）。TACE（vs. TAE）和类癌肿瘤与更大的反应相关（p<0.05）。病变反应不能通过治疗前的大小、血管生成或组织学来预测。RECIST 部分缓解（PR）率为 12.3%，所有部分缓解者均在 TACE 组。神经内分泌肿瘤，特别是类癌病变，PR 率明显更高（p<0.05）。然而，总体生存率与组织学或影像学反应无关。
TAE 和 TACE 根据 RECIST 标准产生显著的客观治疗反应。反应在神经内分泌肿瘤中最大，与血管生成和病变大小无关。TACE 似乎优于 TAE。尽管反应与改善生存之间存在关联，但需要进行大规模队列研究来进一步确定这种关系。
