Li Hui, Wu Fucang, Duan Min, Zhang Guodong
Department of Intervention, Jining No.1 People's Hospital.
Department of Intervention, Jining Infectious Disease Hospital.
Medicine (Baltimore). 2019 May;98(21):e15314. doi: 10.1097/MD.0000000000015314.
This study aimed to compare the efficacy and safety of drug-eluting bead transarterial chemoembolization (DEB-TACE) vs conventional TACE (cTACE) in hepatocellular carcinoma (HCC) patients with multiple cTACE treatments history.Eighty-one HCC patients with multiple cTACE treatments history who underwent DEB-TACE (N = 42) and cTACE treatment (N = 39) were included in this retrospective cohort study and allocated to DEB-TACE and cTACE groups accordingly. Multiple cTACE treatments history was defined as history of three or more cycles cTACE treatments. Then treatment responses were assessed according to the criteria of modified Response Evaluation Criteria in Solid Tumors (mRECIST), and progression free survival (PFS), as well as overall survival (OS), was calculated. In addition, adverse events and liver function related indexes were recorded.Complete response (P = .167) was of no difference while objective response rate (ORR) (P = .003) was increased in DEB-TACE group compared with cTACE group. Patients in DEB-TACE group presented with more favorable PFS (P = .028) and OS (P = .037) compared with cTACE group. Further analysis revealed that DEB-TACE (vs cTACE) was an independent predictive factor for better ORR (P = .001), PFS (P = .006) and OS (P = .001). The albumin (ALB) level at first month after treatment was elevated (P = .015) while the other liver function indexes levels did not vary (all P > .05) in DEB-TACE group compared with cTACE group. The incidences of pain (P = .327), fever (P = .171) and nausea/vomiting (P = .400) during hospitalization were similar between the 2 groups.DEB-TACE is more efficient and equally tolerant compared with cTACE in HCC patients with multiple cTACE treatments history.
本研究旨在比较载药微球经动脉化疗栓塞术(DEB-TACE)与传统经动脉化疗栓塞术(cTACE)在有多次cTACE治疗史的肝细胞癌(HCC)患者中的疗效和安全性。本回顾性队列研究纳入了81例有多次cTACE治疗史的HCC患者,这些患者接受了DEB-TACE治疗(n = 42)和cTACE治疗(n = 39),并相应地分为DEB-TACE组和cTACE组。多次cTACE治疗史定义为三个或更多周期cTACE治疗的病史。然后根据改良实体瘤疗效评价标准(mRECIST)评估治疗反应,并计算无进展生存期(PFS)和总生存期(OS)。此外,记录不良事件和肝功能相关指标。完全缓解(P = 0.167)无差异,而DEB-TACE组的客观缓解率(ORR)(P = 0.003)较cTACE组升高。与cTACE组相比,DEB-TACE组患者的PFS(P = 0.028)和OS(P = 0.037)更优。进一步分析显示,DEB-TACE(与cTACE相比)是ORR更佳(P = 0.001)、PFS更佳(P = 0.006)和OS更佳(P = 0.001)的独立预测因素。与cTACE组相比,DEB-TACE组治疗后第一个月的白蛋白(ALB)水平升高(P = 0.015),而其他肝功能指标水平无变化(所有P > 0.05)。两组住院期间疼痛(P = 0.327)、发热(P = 0.171)和恶心/呕吐(P = 0.400)的发生率相似。在有多次cTACE治疗史的HCC患者中,DEB-TACE与cTACE相比更有效且耐受性相当。