Manchester Medical School, The University of Manchester, Manchester, United Kingdom,
Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.
Neuroendocrinology. 2021;111(4):354-369. doi: 10.1159/000507194. Epub 2020 Mar 13.
Liver embolisation is one of the treatment options available for patients diagnosed with neuro-endocrine neoplasms (NEN). It is still uncertain whether the benefits of the various types of embolisation treatments truly outweigh the complications in NENs. This systematic review assesses the available data relating to liver embolisation in patients with NENs.
Eligible studies (identified using MEDLINE-PubMed) were those reporting data on NEN patients who had undergone any type of liver embolisation. The primary end points were best radiological response and symptomatic response; secondary end-points included progression-free survival (PFS), overall survival (OS) and toxicity.
Of 598 studies screened, 101 were eligible: 16 were prospective (15.8%). The eligible studies included a total of 5,545 NEN patients, with a median of 39 patients per study (range 5-214). Pooled rate of partial response was 36.6% (38.9% achieved stable disease) and 55.2% of patients had a symptomatic response to therapy when pooled data were analysed. The median PFS and OS were 18.4 months (95% CI 15.5-21.2) and 40.7 months (95% CI 35.2-46.2) respectively. The most common toxicities were found to be abdominal pain (48.8%) and nausea (48.1%). Outcome did not significantly vary depending on the type of embolisation performed.
Liver embolisation provides adequate symptom relief for patients with carcinoid syndrome and is also able to reach partial response in a significant proportion of patients and a reasonable PFS. Quality of studies was limited, highlighting the need of further prospective studies to confirm the most suitable form of liver embolisation in NENs.
肝栓塞治疗是神经内分泌肿瘤（NEN）患者的治疗选择之一。目前尚不确定各种类型的栓塞治疗的益处是否真的超过 NEN 的并发症。本系统评价评估了与 NEN 患者肝栓塞治疗相关的现有数据。
符合条件的研究（通过 MEDLINE-PubMed 确定）是报告了接受任何类型肝栓塞治疗的 NEN 患者数据的研究。主要终点是最佳影像学反应和症状反应；次要终点包括无进展生存期（PFS）、总生存期（OS）和毒性。
在筛选的 598 项研究中，有 101 项符合条件：其中 16 项为前瞻性（15.8%）。合格研究共纳入 5545 例 NEN 患者，每项研究的中位数为 39 例（范围 5-214 例）。当汇总数据进行分析时，部分缓解的累积率为 36.6%（38.9%达到稳定疾病），55.2%的患者对治疗有症状反应。中位 PFS 和 OS 分别为 18.4 个月（95%CI 15.5-21.2）和 40.7 个月（95%CI 35.2-46.2）。最常见的毒性是腹痛（48.8%）和恶心（48.1%）。结果并未因所进行的栓塞类型而显著变化。
肝栓塞治疗可为类癌综合征患者提供充分的症状缓解，并且还能够使相当一部分患者达到部分缓解，并获得合理的 PFS。研究质量有限，这突出表明需要进一步的前瞻性研究来确定 NEN 中最适合的肝栓塞形式。
