Han Kichang, Yoon Ki Woong, Kim Jin Hyoung, Kim Gyoung Min
Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Korea.
J Vasc Interv Radiol. 2019 Mar;30(3):428-434. doi: 10.1016/j.jvir.2018.08.022.
To evaluate the safety and efficacy of bronchial artery embolization (BAE) in patients with primary lung cancer-related hemoptysis and to identify factors associated with hemoptysis-free survival.
Data from 84 patients with primary lung cancer (non-small cell [n = 74] and small cell [n = 10]) who underwent BAE from 1997 to 2018 for the management of hemoptysis were retrospectively reviewed. Of these, 53 patients had stage IV lung cancer. The hemoptysis volume prior to initial BAE was trivial (blood-tinged sputum) in 21 patients, moderate (< 300 mL per 24 hours) in 34 patients, and massive (> 300 mL per 24 hours) in 29 patients.
Technical success, defined as the ability to selectively embolize the abnormal vessel, was achieved in 83 patients (98.8%), and clinical success was achieved in 69 (82.1%) patients. Polyvinyl alcohol particles were used to embolize in 51 patients, gelfoam in 15 patients, and gelfoam plus microcoils in 17 patients. Hemoptysis recurred in 20 patients (23.8%) during follow-up. The median hemoptysis-free survival and overall survival periods were both 61 days. In the clinical-success and clinical-failure groups, the median overall survival period was 99 and 9 days, respectively (P < .001). In multivariable analysis, massive hemoptysis (P = .012) and cavitary lung mass (P = .019) were predictive factors for shortened hemoptysis-free survival.
BAE is a safe and effective approach to control hemoptysis, although the prognosis in primary lung cancer patients presenting with hemoptysis is generally poor. Massive hemoptysis and cavitary lung mass are significant predictors of shortened hemoptysis-free survival.
评估支气管动脉栓塞术（BAE）治疗原发性肺癌相关咯血的安全性和有效性，并确定与无咯血生存期相关的因素。
回顾性分析1997年至2018年期间因咯血接受BAE治疗的84例原发性肺癌患者（非小细胞肺癌[n = 74]和小细胞肺癌[n = 10]）的数据。其中，53例患者为IV期肺癌。初次BAE前咯血程度为少量（痰中带血）的患者有21例，中度（每24小时<300 mL）的患者有34例，大量（每24小时>300 mL）的患者有29例。
83例患者（98.8%）实现了技术成功，即能够选择性栓塞异常血管，69例患者（82.1%）实现了临床成功。51例患者使用聚乙烯醇颗粒进行栓塞，15例患者使用明胶海绵，17例患者使用明胶海绵加微线圈。随访期间，20例患者（23.8%）咯血复发。无咯血生存期和总生存期的中位数均为61天。在临床成功组和临床失败组中，总生存期的中位数分别为99天和9天（P <.001）。多变量分析显示，大量咯血（P =.012）和空洞性肺肿块（P =.019）是无咯血生存期缩短的预测因素。
BAE是控制咯血的一种安全有效的方法，尽管原发性肺癌咯血患者的预后通常较差。大量咯血和空洞性肺肿块是无咯血生存期缩短的重要预测因素。
