Langman Eun L, Suhocki Paul V, Hurwitz Herbert I, Morse Michael A, Burbridge Rebecca A, Smith Tony P, Kim Charles Y
Division of Vascular & Interventional Radiology, Duke University Medical Center, Durham, NC 27710, USA.
Division of Medical Oncology, Duke University Medical Center, Durham, NC 27710, USA.
J Gastrointest Oncol. 2016 Dec;7(6):875-881. doi: 10.21037/jgo.2016.06.13.
Patients with metastatic disease of the liver can have hyperbilirubinemia due to a number of reasons, including biliary obstruction. The purpose of this study was to analyze patient outcomes after percutaneous biliary drainage (PBD) catheter insertion in patients with extensive hepatic metastatic tumor burden.
Out of 746 PBD insertions, 44 patients (24 males, 20 females, mean age 57.4 years, range, 34-80 years) had metastatic malignancy with a hepatic tumor burden of greater than 20% parenchymal volume based on pre-procedure computed tomography (CT) or magnetic resonance imaging (MRI). Laboratory data before and after PBD insertion were compared. Survival and outcomes analysis performed. A subanalysis was performed on patients with CT-demonstrated catheter traversal of tumoral tissue.
A PBD catheter was successfully inserted in all patients. The mean serum bilirubin level decreased significantly from 10.9±6.4 mg/dL immediately prior to PBD insertion to 7.1±5.6 mg/dL (P<0.001) within one month post PBD insertion. Four patients (11%) demonstrated normalization of bilirubin levels to less than 1.6 mg/dL. Of the 14 patients with a post-procedure CT or MRI, the PBD catheter traversed a tumor in 11 (79%). One of these patients required a transfusion after the procedure and one had recurrent catheter exchanges due to pericatheter leakage. The 30-day overall survival was 41% with a median survival of 19 days. The percentage decrease in serum bilirubin after PBD insertion and pre-procedure international normalized ratio (INR) were correlated with improved survival (OR =3.7, P=0.010 and OR =4.9, P=0.028 respectively). The PBD-associated major complication rate was 16%.
In patients with hyperbilirubinemia and extensive hepatic metastatic disease burden, survival was dismal after PBD catheter insertion. Serum bilirubin level normalization occurred rarely.
肝转移瘤患者可因多种原因出现高胆红素血症，包括胆道梗阻。本研究旨在分析经皮胆道引流（PBD）导管插入术在肝转移瘤负荷广泛的患者中的治疗效果。
在746例PBD导管插入术中，44例患者（男性24例，女性20例，平均年龄57.4岁，范围34 - 80岁）患有转移性恶性肿瘤，根据术前计算机断层扫描（CT）或磁共振成像（MRI），肝肿瘤负荷大于实质体积的20%。比较PBD导管插入术前和术后的实验室数据。进行生存和预后分析。对CT显示导管穿过肿瘤组织的患者进行亚分析。
所有患者均成功插入PBD导管。血清胆红素平均水平从PBD导管插入术前的10.9±6.4mg/dL显著降至PBD导管插入术后1个月内的7.1±5.6mg/dL（P<0.001）。4例患者（11%）胆红素水平恢复正常，低于1.6mg/dL。在术后进行CT或MRI检查的14例患者中，11例（79%）PBD导管穿过肿瘤。其中1例患者术后需要输血，1例因导管周围渗漏反复更换导管。30天总生存率为41%，中位生存期为19天。PBD导管插入术后血清胆红素下降百分比和术前国际标准化比值（INR）与生存率提高相关（分别为OR = 3.7，P = 0.010和OR = 4.9，P = 0.028）。PBD相关的主要并发症发生率为16%。
对于高胆红素血症和肝转移瘤负荷广泛的患者，PBD导管插入术后生存率较低。胆红素水平正常化的情况很少见。
