Monier Arnaud, Guiu Boris, Duran Rafael, Aho Serge, Bize Pierre, Deltenre Pierre, Dunet Vincent, Denys Alban
Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, 1011, 46 rue du Bugnon, Switzerland.
Department of Diagnostic and Interventional Radiology, Montpellier University Hospital, Montpellier, 34000, Avenue Emile Bertin Sans, France.
Eur Radiol. 2017 Apr;27(4):1431-1439. doi: 10.1007/s00330-016-4488-y. Epub 2016 Jul 19.
To compare transarterial chemoembolization (TACE)-related hepatic toxicities of conventional TACE (cTACE) and drug-eluting beads TACE (DEB-TACE) in patients with intermediate-stage hepatocellular carcinoma.
In this retrospective study, 151 consecutive patients undergoing cTACE or DEB-TACE and MRI 3-6 weeks before and after therapy were included. Toxicity was assessed on imaging (global hepatic damages (GHD), overall biliary injuries, biliary cast, bile duct dilatation, intrahepatic biloma, portal thrombosis), and clinico-biological follow-ups. Tumour response, time to progression (TTP), and overall survival were assessed. Factors influencing complication rate were identified by generalized equation logistic regression model.
Biliary injuries and intrahepatic biloma incidence were significantly higher following DEB-TACE (p < 0.001). DEB-TACE showed a significant increased risk of GHD (OR: 3.13 [1.74-5.63], p < 0.001) and biliary injuries (OR: 4.53 [2.37-8.67], p < 0.001). A significant relationship was found between baseline prothrombin value and GHD, biliary injuries and intrahepatic biloma (all p < 0.01), and between the dose of chemotherapy and intrahepatic biloma (p = 0.001). Only TTP was significantly shorter following DEB-TACE compared to cTACE (p = 0.025).
DEB-TACE was associated with increased hepatic toxicities compared to cTACE. GHD, biliary injuries, and intrahepatic biloma were more frequently observed with high baseline prothrombin value, suggesting that cTACE might be more appropriate than DEB-TACE in patients with less advanced cirrhosis.
• DEB-TACE demonstrated more therapy-related hepatic locoregional complications compared to cTACE. • TACE-related hepatic locoregional toxicities occurred more frequently with high baseline PT value. • cTACE may be more appropriate in patients with high baseline PT value.
比较经动脉化疗栓塞术（TACE）治疗中期肝细胞癌患者时，传统TACE（cTACE）与载药微球TACE（DEB-TACE）相关的肝脏毒性。
在这项回顾性研究中，纳入了151例连续接受cTACE或DEB-TACE治疗且在治疗前后3 - 6周接受MRI检查的患者。通过影像学（整体肝脏损伤（GHD）、总体胆道损伤、胆泥、胆管扩张、肝内胆汁瘤、门静脉血栓形成）以及临床生物学随访评估毒性。评估肿瘤反应、疾病进展时间（TTP）和总生存期。通过广义方程逻辑回归模型确定影响并发症发生率的因素。
DEB-TACE术后胆道损伤和肝内胆汁瘤的发生率显著更高（p < 0.001）。DEB-TACE显示GHD（比值比：3.13 [1.74 - 5.63]，p < 0.001）和胆道损伤（比值比：4.53 [2.37 - 8.67]，p < 0.001）的风险显著增加。发现基线凝血酶原值与GHD、胆道损伤和肝内胆汁瘤之间存在显著关系（均p < 0.01），化疗剂量与肝内胆汁瘤之间也存在显著关系（p = 0.001）。与cTACE相比，仅DEB-TACE后的TTP显著更短（p = 0.025）。
与cTACE相比，DEB-TACE与肝脏毒性增加相关。基线凝血酶原值高时，GHD、胆道损伤和肝内胆汁瘤更常出现，这表明在肝硬化程度较轻的患者中，cTACE可能比DEB-TACE更合适。
• 与cTACE相比，DEB-TACE显示出更多与治疗相关的肝脏局部区域并发症。• TACE相关的肝脏局部区域毒性在基线PT值高时更频繁发生。• 基线PT值高的患者中，cTACE可能更合适。
