经动脉治疗神经内分泌肿瘤肝转移：使用倾向评分分析模型比较常规 TACE、载药微球 TACE 和钇 90 放射性栓塞作为治疗选择。
Intra-arterial therapy of neuroendocrine tumour liver metastases: comparing conventional TACE, drug-eluting beads TACE and yttrium-90 radioembolisation as treatment options using a propensity score analysis model.
机构信息
Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany.
Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
出版信息
Eur Radiol. 2017 Dec;27(12):4995-5005. doi: 10.1007/s00330-017-4856-2. Epub 2017 Jul 4.
OBJECTIVES
To compare efficacy, survival outcome and prognostic factors of conventional transarterial chemoembolisation (cTACE), drug-eluting beads TACE (DEB-TACE) and yttrium-90 radioembolisation (Y90) for the treatment of liver metastases from gastroenteropancreatic (GEP) neuroendocrine tumours (NELM).
METHODS
This retrospective analysis included 192 patients (58.6 years mean age, 56% men) with NELM treated with cTACE (N = 122), DEB-TACE (N = 26) or Y90 (N = 44) between 2000 and 2014. Radiologic response to therapy was assessed according to Response Evaluation Criteria in Solid Tumours (RECIST) and World Health Organization (WHO) criteria using periprocedural MR imaging. Survival analysis included propensity score analysis (PSA), median overall survival (MOS), hepatic progression-free survival, Kaplan-Meier using log-rank test and the uni- and multivariate Cox proportional hazards model (MVA).
RESULTS
MOS of the entire study population was 28.8 months. As for cTACE, DEB-TACE and Y90, MOS was 33.8 months, 21.7 months and 23.6 months, respectively. According to the MVA, cTACE demonstrated a significantly longer MOS as compared to DEB-TACE (p <.01) or Y90 (p = .02). The 5-year survival rate after initial cTACE, DEB-TACE and Y90 was 28.2%, 10.3% and 18.5%, respectively.
CONCLUSIONS
Upon PSA, our study suggests significant survival benefits for patients treated with cTACE as compared to DEB-TACE and Y90. This data supports the therapeutic decision for cTACE as the primary intra-arterial therapy option in patients with unresectable NELM until proven otherwise.
KEY POINTS
• cTACE achieved a significantly longer overall survival in patients with unresectable NELM. • Patients treated with cTACE showed a prolonged hepatic progression-free survival. • cTACE, DEB-TACE and Y90 radioembolisation demonstrated comparable safety and toxicity profiles. • Age >70 years, extrahepatic metastases and tumour burden >50% were identified as negative predictors. • Propensity score analysis suggests the superiority of cTACE over DEB-TACE and Y90.
目的
比较常规经动脉化疗栓塞术（cTACE）、载药微球 TACE（DEB-TACE）和钇 90 放射性栓塞术（Y90）治疗胃肠胰神经内分泌肿瘤（GEP-NET）肝转移的疗效、生存结局和预后因素。
方法
本回顾性分析纳入了 2000 年至 2014 年间接受 cTACE（n=122）、DEB-TACE（n=26）或 Y90（n=44）治疗的 192 例 GEP-NET 肝转移患者（中位年龄 58.6 岁，56%为男性）。采用实体瘤反应评估标准（RECIST）和世界卫生组织（WHO）标准，通过围手术期磁共振成像评估治疗的影像学反应。生存分析包括倾向评分分析（PSA）、中位总生存期（MOS）、肝无进展生存期、Kaplan-Meier 对数秩检验和单因素及多因素 Cox 比例风险模型（MVA）。
结果
全组患者 MOS 为 28.8 个月。cTACE、DEB-TACE 和 Y90 的 MOS 分别为 33.8 个月、21.7 个月和 23.6 个月。根据 MVA，cTACE 的 MOS 明显长于 DEB-TACE（p<.01）或 Y90（p=.02）。初始 cTACE、DEB-TACE 和 Y90 治疗后的 5 年生存率分别为 28.2%、10.3%和 18.5%。
结论
经过 PSA，本研究表明与 DEB-TACE 和 Y90 相比，cTACE 治疗的患者具有显著的生存获益。这些数据支持在无法切除的 GEP-NELM 患者中，cTACE 作为首选的动脉内治疗方案，除非有其他证据。
关键点
· cTACE 可显著延长不可切除的 GEP-NELM 患者的总生存期。
· 接受 cTACE 治疗的患者显示出延长的肝无进展生存期。
· cTACE、DEB-TACE 和 Y90 放射性栓塞的安全性和毒性谱相当。
· 年龄>70 岁、肝外转移和肿瘤负荷>50%被确定为负预测因素。
· 倾向评分分析表明 cTACE 优于 DEB-TACE 和 Y90。
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