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不可切除性肝内胆管癌的经动脉栓塞治疗:一项系统评价

Trans-arterial embolisation therapies for unresectable intrahepatic cholangiocarcinoma: a systematic review.

作者信息

Yang Linda, Shan Jocelyn, Shan Leonard, Saxena Akshat, Bester Lourens, Morris David L

机构信息

1 Melbourne Medical School, The University of Melbourne, Victoria, Australia ; 2 Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia ; 3 Department of Surgery, St George Hospital, Kogarah, New South Wales, Australia ; 4 Department of Radiology, School of Medicine, University of Notre Dame, Darlinghurst, New South Wales, Australia.

出版信息

J Gastrointest Oncol. 2015 Oct;6(5):570-88. doi: 10.3978/j.issn.2078-6891.2015.055.

Abstract

BACKGROUND

Unresectable intrahepatic cholangiocarcinoma (ICC) portends a poor prognosis despite standard systemic treatments which confer minimal survival benefits and significant adverse effects. This study aimed to assess clinical outcomes, complications and prognostic factors of TAE therapies using chemotherapeutic agents or radiation.

METHODS

A literature search and article acquisition was conducted on PubMed (MEDLINE), OVID (MEDLINE) and EBSCOhost (EMBASE). Original articles published after January 2000 on trans-arterial therapies for unresectable ICC were selected using strict eligibility criteria. Radiological response, overall survival, progression-free survival, safety profile, and prognostic factors for overall survival were assessed. Quality appraisal and data tabulation were performed using pre-determined forms. Results were synthesized by narrative review and quantitative analysis.

RESULTS

Twenty articles were included (n=929 patients). Thirty three percent of patients presented with extrahepatic metastases. After treatment, the average rate of complete and partial radiological response was 10% and 22.2%, respectively. Overall median survival time was 12.4 months with a median 30-day mortality and 1-year survival rate of 0.6% and 53%, respectively. Acute treatment toxicity (within 30 days) was reported in 34.9% of patients, of which 64.3% were mild to moderate in severity. The most common clinical toxicities were abdominal pain, nausea and vomiting, and fatigue. Multiplicity, localization and vascularity of the tumor may predict worse overall survival.

CONCLUSIONS

Trans-arterial therapies are safe and effective treatment options which should be considered routinely for unresectable ICC. Consistent and standardized methodology and data collection is required to facilitate a meta-analysis. Randomized controlled trials will be valuable in the future.

摘要

背景

尽管标准的全身治疗对不可切除的肝内胆管癌(ICC)患者生存获益极小且有显著不良反应,但此类患者预后仍较差。本研究旨在评估使用化疗药物或放疗的经动脉栓塞化疗(TAE)治疗的临床疗效、并发症及预后因素。

方法

在PubMed(医学文献数据库)、OVID(医学文献数据库)和EBSCOhost(EMBASE)上进行文献检索并获取文章。采用严格的纳入标准,选取2000年1月以后发表的关于不可切除ICC经动脉治疗的原始文章。评估放射学反应、总生存期、无进展生存期、安全性及总生存期的预后因素。使用预先确定的表格进行质量评估和数据制表。通过叙述性综述和定量分析对结果进行综合。

结果

纳入20篇文章(共929例患者)。33%的患者出现肝外转移。治疗后,完全和部分放射学反应的平均发生率分别为10%和22.2%。总中位生存期为12.4个月,30天中位死亡率和1年生存率分别为0.6%和53%。34.9%的患者报告有急性治疗毒性(30天内),其中64.3%为轻度至中度。最常见的临床毒性为腹痛、恶心呕吐和疲劳。肿瘤的多灶性、位置及血管情况可能预示总生存期较差。

结论

经动脉治疗是安全有效的治疗选择,对于不可切除的ICC应常规考虑。需要一致且标准化的方法和数据收集以促进荟萃分析。未来随机对照试验将很有价值。

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