Department of Surgery, Riverside Methodist Hospital, Columbus, OH, USA.
Ann Surg Oncol. 2013 Apr;20(4):1114-20. doi: 10.1245/s10434-012-2786-4. Epub 2013 Mar 2.
Transarterial chemoembolization (TACE) is often utilized for patients with inoperable neuroendocrine carcinoma liver metastases. Often, metastatic disease is not limited to the liver. The impact of extrahepatic disease (EHD) on outcomes and response after TACE has not been described.
We reviewed 192 patients who underwent TACE for large hepatic tumor burden, progression of liver metastases, or poorly controlled carcinoid syndrome due to neuroendocrine carcinoma. Demographics, clinicopathologic characteristics, response to TACE, complications, and survival were compared between patients with (n = 123) and without (n = 69) EHD.
Demographics, histopathologic characteristics, and complications were similar between groups. As well, those with and without EHD had similar biochemical (85 vs. 88 %) and radiographic response (76 vs. 79 %) to TACE (all p = NS); however, symptomatic responses were improved in those with EHD (79 vs. 60 %, p = 0.01). The group without EHD had better overall survival compared to those with EHD disease at the time of TACE (median 62 vs. 28 months, p = 0.001).
Although patients with EHD from neuroendocrine carcinoma experience shorter overall survival after TACE compared to those without EHD, they had similar symptomatic, biochemical, and radiographic response to TACE. Meaningful response to TACE is still possible in the presence of EHD and should be considered, particularly in those with carcinoid syndrome.
经动脉化疗栓塞术（TACE）常用于治疗无法手术的神经内分泌癌肝转移患者。通常，转移性疾病并不局限于肝脏。肝外疾病（EHD）对 TACE 后结局和反应的影响尚未描述。
我们回顾了 192 例因大肝肿瘤负荷、肝转移进展或神经内分泌癌引起的类癌综合征无法控制而行 TACE 的患者。比较了有（n=123）和无（n=69）EHD 患者的人口统计学、临床病理特征、TACE 反应、并发症和生存情况。
两组患者的人口统计学、组织病理学特征和并发症相似。同样，有和无 EHD 的患者 TACE 的生化反应（85%与 88%）和影像学反应（76%与 79%）相似（所有 p 值均>0.05）；然而，有 EHD 的患者症状反应更好（79%与 60%，p=0.01）。在 TACE 时患有 EHD 的患者总体生存率明显低于无 EHD 的患者（中位生存时间 62 个月与 28 个月，p=0.001）。
尽管与无 EHD 的患者相比，患有 EHD 的神经内分泌癌患者在接受 TACE 后总体生存率较短，但他们对 TACE 的症状、生化和影像学反应相似。在存在 EHD 的情况下，TACE 仍有可能获得有意义的反应，特别是在患有类癌综合征的患者中应考虑进行 TACE。
