Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), 1 Department of Interventional Therapy, 2 Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Chin J Cancer Res. 2014 Feb;26(1):124-31. doi: 10.3978/j.issn.1000-9604.2014.02.11.
Transcatheter arterial chemoembolization (TACE) is a standard treatment for hepatocellular carcinoma (HCC) and/or some unresectable liver metastasis tumors. Hypervascular liver metastatic lesions such as metastasis from gastrointestinal stromal tumor (GIST) are an indication for transcatheter arterial embolization (TAE). The purpose of this study was to evaluate the efficacy and safety of Embosphere(®)-TAE (Embo-TAE) in comparison with conventional TACE (cTACE) for the treatment of liver metastasis from GIST.
A total of 45 patients who underwent TACE between Aug 2008 and Feb 2013 were enrolled. Patients with GIST who underwent TAE with Embosphere(®) (n=19) were compared with controls who received cTACE (n=26). The primary end points were treatment response and treatment-related adverse events. The secondary end points were progression-free survival (PFS) and overall survival (OS).
The treatment response of Embo-TAE group was significantly higher than that of the cTACE group (P<0.001). The PFS was significantly better in the Embosphere(®)-group than in the cTACE group (56.6 and 42.1 weeks, respectively; P=0.003). However, there was no statistically significant difference in liver toxicity between the two groups (P>0.05). The median OS in the Embo-TAE group was longer than that in the cTACE group (74.0 weeks, 95% CI: 68.2-79.8 vs. 61.7 weeks, 95% CI: 56.2-67.2 weeks) (unadjusted P=0.045). The use of Embo-TAE significantly reduced the risk of death in patients with GIST with liver metastases according to the Cox proportional hazards regression model [hazard ratio (HR): 0.149; 95% CI: 0.064-0.475].
TAE with Embosphere(®) showed better treatment response and delayed tumor progression compared with cTACE. There was no significant difference in treatment-related hepatic toxicities. Embo-TAE thus appears to be a feasible and promising approach in the treatment of liver metastasis from GIST.
经导管动脉化疗栓塞术（TACE）是治疗肝细胞癌（HCC）和/或某些不可切除的肝转移瘤的标准治疗方法。胃肠道间质瘤（GIST）等富血管性肝转移病灶是经导管动脉栓塞术（TAE）的适应证。本研究旨在评估与常规 TACE（cTACE）相比，使用 Embosphere（®）-TAE（Embo-TAE）治疗 GIST 肝转移的疗效和安全性。
共纳入 2008 年 8 月至 2013 年 2 月期间接受 TACE 治疗的 45 例患者。接受 Embosphere（®）TAE（n=19）的 GIST 患者与接受 cTACE（n=26）的对照组进行比较。主要终点为治疗反应和与治疗相关的不良事件。次要终点为无进展生存期（PFS）和总生存期（OS）。
Embo-TAE 组的治疗反应明显高于 cTACE 组（P<0.001）。Embosphere（®）组的 PFS 明显优于 cTACE 组（56.6 和 42.1 周，分别；P=0.003）。然而，两组之间的肝毒性无统计学差异（P>0.05）。Embo-TAE 组的中位 OS 长于 cTACE 组（74.0 周，95%CI：68.2-79.8 与 61.7 周，95%CI：56.2-67.2 周）（未调整的 P=0.045）。根据 Cox 比例风险回归模型，使用 Embo-TAE 可显著降低 GIST 伴肝转移患者的死亡风险[风险比（HR）：0.149；95%CI：0.064-0.475]。
与 cTACE 相比，使用 Embosphere（®）的 TAE 显示出更好的治疗反应和肿瘤进展延迟。与治疗相关的肝毒性无显著差异。因此，Embo-TAE 似乎是治疗 GIST 肝转移的一种可行且有前途的方法。
