Department of Interventional Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences.
Department of Geriatrics, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong.
Medicine (Baltimore). 2021 Jul 2;100(26):e26441. doi: 10.1097/MD.0000000000026441.
This study retrospectively studied transarterial chemoembolization (TACE) combined with partial splenic embolization (PSE) in the treatment of hepatocellular carcinoma (HCC) with severe hypersplenism.Seventy patients with HCC in Barcelona Clinic Liver Cancer (BCLC) stage B or C with hypersplenism were divided into non-partial splenic embolization group (N-PSE, n = 51) and partial splenic embolization group (PSE, n = 19). The N-PSE group was further divided into N-PSE with mild to moderate hypersplenism (N-PSE-M, 47 cases) and N-PSE with severe hypersplenism (N-PSE-S, 4 cases).In the PSE group, leukocytes, neutrophils, lymphocytes, and platelets were significantly increased (P < .05) and were significantly different from that in the N-PSE group (P < .05). In the N-PSE group, except for a slight increase in neutrophils, other blood cells were decreased, including lymphocytes that were significantly decreased (P < .05). There was no significant difference in the changes of liver function between the 2 groups before and after surgery (P > .05). The analysis showed a significant increase in ascites after 6 months of TACE in the N-PSE group (P < .05). According to the follow-up results, the median overall survival (OS) in the PSE group was 24.47 ± 3.68 (months) and progression-free survival (PFS) was 12.63 ± 4.98 (months). Regardless of OS or PFS, the PSE group was superior to the N-PSE group and its subgroups, with a statistically significant difference in PFS between the N-PSE group and PSE group (P < .05). Moreover, the time of extrahepatic progression was significantly earlier in the N-PSE group than in the PSE group (P < .05). N-PSE-S group had the worst prognosis, and PFS and OS were worse than the other 2 groups, suggesting that PSE in severe hypersplenism may improve PFS and OS.In patients with HCC and severe hypersplenism, TACE should be actively combined with PSE treatment.
本研究回顾性分析了经肝动脉化疗栓塞术（TACE）联合部分性脾动脉栓塞术（PSE）治疗巴塞罗那临床肝癌（BCLC）分期 B 或 C 伴有严重脾功能亢进的肝细胞癌（HCC）患者的疗效。70 例 BCLC 分期 B 或 C 伴有脾功能亢进的 HCC 患者分为非部分性脾动脉栓塞组（N-PSE，n=51）和部分性脾动脉栓塞组（PSE，n=19）。N-PSE 组进一步分为伴有轻-中度脾功能亢进的 N-PSE 组（N-PSE-M，47 例）和伴有严重脾功能亢进的 N-PSE 组（N-PSE-S，4 例）。在 PSE 组中，白细胞、中性粒细胞、淋巴细胞和血小板显著增加（P＜.05），且与 N-PSE 组比较差异有统计学意义（P＜.05）。N-PSE 组中，除中性粒细胞略有增加外，其他血细胞均减少，包括淋巴细胞显著减少（P＜.05）。两组术后肝功能变化差异无统计学意义（P＞.05）。分析显示，N-PSE 组 TACE 后 6 个月腹水明显增加（P＜.05）。根据随访结果，PSE 组的中位总生存期（OS）为 24.47±3.68（月），无进展生存期（PFS）为 12.63±4.98（月）。无论 OS 还是 PFS，PSE 组均优于 N-PSE 组及其亚组，N-PSE 组与 PSE 组的 PFS 差异有统计学意义（P＜.05）。此外，N-PSE 组肝外进展时间明显早于 PSE 组（P＜.05）。N-PSE-S 组预后最差，PFS 和 OS 均差于其他 2 组，提示严重脾功能亢进时行 PSE 治疗可能改善 PFS 和 OS。对于 HCC 合并严重脾功能亢进的患者，应积极行 TACE 联合 PSE 治疗。
