Hongyo Hidenari, Higashihara Hiroki, Osuga Keigo, Kashiwagi Eiji, Kosai Shinya, Nagai Keisuke, Tanaka Kaishu, Ono Yusuke, Ujike Takeshi, Uemura Motohide, Imamura Ryoichi, Nonomura Norio, Tomiyama Noriyuki
Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan.
Department of Diagnostic Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan.
CVIR Endovasc. 2020 Nov 21;3(1):84. doi: 10.1186/s42155-020-00179-2.
Transcatheter arterial embolization (TAE) has been widely performed for renal angiomyolipomas (AMLs) as prophylaxis or emergency treatment. On the other hand, mammalian target of rapamycin (mTOR) inhibitors have recently been used for tuberous sclerosis (TSC)-related AMLs, and no comparison between the effectiveness of mTOR inhibitors versus prophylactic selective TAE has yet been performed. Therefore, the purpose of this study was to evaluate the efficacy of TAE for AML tumor volume reduction and predictors of tumor volume decrease over 50%, with reference to the EXIST-2 trial.
A total of 44 patients who underwent 48 prophylactic embolization procedures for 50 AMLs in a single institution between 2004 and 2018 were included. Indications for TAE of AMLs were tumor size ≥4 cm or aneurysm ≥5 mm in diameter on contrast-enhanced computed tomography (CECT). Microspheres, ethanol, and micro-coils were used as embolic agents. The percentage volume reduction from before TAE to the minimum volume during follow-up after TAE was calculated, and predictors for 50% volume reduction were identified by univariate and multivariate binary logistic regression analyses.
The technical success rate was 100% (50 of 50). No severe acute complications related to the procedure were encountered. Tumor volume reduction of ≥50% was observed in 35/50 AMLs. There was a significant difference in the rate of tumor volume reduction of 50% between the presence and absence of an aneurysm ≥5 mm and between tumor diameter ≥ 70 mm and < 70 mm on univariate analysis. On multivariate analysis, tumor diameter < 70 mm was the only independent predictor of significant tumor volume reduction after TAE.
Prophylactic selective TAE for AMLs has good tumor-reduction effects, especially for AMLs with tumor diameter < 70 mm.
经导管动脉栓塞术（TAE）已广泛应用于肾血管平滑肌脂肪瘤（AML）的预防或紧急治疗。另一方面，雷帕霉素靶蛋白（mTOR）抑制剂最近已用于治疗结节性硬化症（TSC）相关的AML，但尚未对mTOR抑制剂与预防性选择性TAE的疗效进行比较。因此，本研究的目的是参照EXIST - 2试验，评估TAE对AML肿瘤体积缩小的疗效以及肿瘤体积缩小超过50%的预测因素。
纳入2004年至2018年在单一机构接受50例AML的48例预防性栓塞手术的44例患者。AML的TAE指征为在对比增强计算机断层扫描（CECT）上肿瘤大小≥4 cm或动脉瘤直径≥5 mm。微球、乙醇和微线圈用作栓塞剂。计算TAE前至TAE后随访期间最小体积的体积缩小百分比，并通过单因素和多因素二元逻辑回归分析确定体积缩小50%的预测因素。
技术成功率为100%（50例中的50例）。未遇到与手术相关的严重急性并发症。50例AML中有35例观察到肿瘤体积缩小≥50%。单因素分析显示，存在或不存在直径≥5 mm的动脉瘤以及肿瘤直径≥70 mm和<70 mm之间，肿瘤体积缩小50%的发生率存在显著差异。多因素分析显示，肿瘤直径<70 mm是TAE后肿瘤体积显著缩小的唯一独立预测因素。
AML的预防性选择性TAE具有良好的肿瘤缩小效果，尤其是对于肿瘤直径<70 mm的AML。
