Li Z, Ye B C, Xie R Y, Wang Y Y, Zhang H T, Hu X, Li Y, Wu P L, Ge P, Yu B L, Wu Bailu
Department of Interventional Radiology, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Gan Zang Bing Za Zhi. 2022 Jun 20;30(6):612-617. doi: 10.3760/cma.j.cn501113-20210811-00394.
To compare and analyze the clinical curative effect and safety of chemoembolization with drug-loaded microspheres of different particle sizes (D-TACE) for the treatment of hepatocellular carcinoma. Clinical data of 281 cases with hepatocellular carcinoma treated with drug-loaded microspheres-transarterial chemoembolization (TACE) were retrospectively analyzed. According to the different particle sizes of drug-loaded microspheres, they were divided into 100300 µm (small particle size) and 300500 µm (large particle size) group. Tumor response rate and complication conditions at 1, 3, and 6 months after chemoembolization were compared. The overall survival time of the two groups were analyzed. Quantitative data conformed to normal distribution and homogeneity of variance were compared using t-test, while other with Wilcoxon signed rank-sum test. Qualitative data were compared using test. Kaplan-Meier method was used for survival analysis, and the differences in survival were analyzed using Log-rank test. ＜0.05 was considered as statistically significant. Survival curves and histograms were drawn using GraphPad Prism9.1 software. The complete remission rates at 1, 3 and 6 months after surgery in the small and large particle size groups were 31.25%, 30.15%, and 42.45% and 18.25%, 15.79% and 24.74%, respectively, and the differences were statistically significant between groups (P=0.012, P=0.009, P=0.008, ＜0.05). The objective remission rates at 1, 3 and 6 months after surgery in the small and large particle size groups were 88.19%, 76.99%, and 70.75% and 81.02%, 72.81% and 53.60%, respectively. Six months after surgery, the small particle size group (objective response rate = 70.75%) was significantly higher than the large particle size group (objective response rate=53.6%, =0.012). The disease control rates of the small particle size group were 95.14%, 83.33%, and 74.53%, while large particle size group were 91.24%, 81.58%, and 64.95%, respectively, with no statistically significant difference between the two groups. However, the incidence of postoperative biliary tumors (6.20%) was significantly higher in the small-size than large-size group (0.70%), and the difference was statistically significant (＜0.05, =0.03). There were no statistically significant differences between other adverse events such as post-embolization syndrome, liver abscess, and myelosuppression. The median survival time of the small and large particle size groups was 31.8 months and 20.5 months, respectively, but the difference was not statistically significant (=0.182). In the treatment of hepatocellular carcinoma with D-TACE, the short-term curative effect of the small particle size group was better than large particle size group, but the incidence of biliary tumors was high, and D-TACE of different particle sizes had no significant effect on long-term survival.
比较分析不同粒径载药微球经动脉化疗栓塞术（D-TACE）治疗肝细胞癌的临床疗效及安全性。回顾性分析281例行载药微球经动脉化疗栓塞术（TACE）治疗的肝细胞癌患者的临床资料。根据载药微球粒径不同，将其分为100300 µm（小粒径）组和300500 µm（大粒径）组。比较化疗栓塞术后1、3、6个月时的肿瘤反应率及并发症情况。分析两组患者的总生存时间。符合正态分布且方差齐性的定量资料采用t检验进行比较，其他定量资料采用Wilcoxon符号秩和检验。定性资料采用检验。采用Kaplan-Meier法进行生存分析，生存差异采用Log-rank检验。P＜0.05为差异有统计学意义。使用GraphPad Prism9.1软件绘制生存曲线和直方图。小粒径组和大粒径组术后1、3、6个月的完全缓解率分别为31.25%、30.15%、42.45%和18.25%、15.79%、24.74%，组间差异有统计学意义（P=0.012、P=0.009、P=0.008，P＜0.05）。小粒径组和大粒径组术后1、3、6个月的客观缓解率分别为88.19%、76.99%、70.75%和81.02%、72.81%、53.60%。术后6个月，小粒径组（客观缓解率=70.75%）显著高于大粒径组（客观缓解率=53.6%，P=0.012）。小粒径组的疾病控制率分别为95.14%、83.33%、74.53%，大粒径组分别为91.24%、81.58%、64.95%，两组间差异无统计学意义。然而，小粒径组术后胆管肿瘤发生率（6.20%）显著高于大粒径组（0.70%），差异有统计学意义（P＜0.05，P=0.03）。栓塞后综合征、肝脓肿、骨髓抑制等其他不良事件两组间差异无统计学意义。小粒径组和大粒径组的中位生存时间分别为31.8个月和20.5个月，但差异无统计学意义（P=0.182）。在D-TACE治疗肝细胞癌中，小粒径组短期疗效优于大粒径组，但胆管肿瘤发生率高，不同粒径D-TACE对长期生存无显著影响。
