接受转化性肝切除术患者的术前经动脉药物洗脱微球化疗栓塞术（DEB-TACE）：一项倾向评分匹配分析

Preoperative transarterial chemoembolization with drug-eluting beads (DEB-TACE) in patients undergoing conversional hepatectomy: a propensity-score matching analysis.

作者信息

Liu Yu, Zhou Bo, Tang Wentao, Xu Donghao, Yan Zhiping, Ren Li, Zhu Dexiang, He Guodong, Wei Ye, Chang Wenju, Xu Jianmin

机构信息

Colorectal Cancer Centre, Zhongshan Hospital, Fudan University, Shanghai, China.

Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.

出版信息

Eur Radiol. 2023 Feb;33(2):1022-1030. doi: 10.1007/s00330-022-09063-0. Epub 2022 Sep 6.

DOI:10.1007/s00330-022-09063-0

PMID:36066736

Abstract

OBJECTIVES

Patients with colorectal liver metastases (CRLM) who underwent hepatic resection after conversion therapy had a high recurrence rate of nearly 90%. Preoperative DEB-TACE has the potential to prevent postoperative recurrence which has not been elucidated. The objective of this study was to evaluate the safety and efficacy of preoperative DEB-TACE.

MATERIALS AND METHODS

Patients with CRLM who underwent liver resection from June 1, 2016, to June 30, 2021, were collected and those who received conversional hepatectomy were included in this study. Patients with preoperative DEB-TACE were propensity-score matched in a 1:1 ratio to patients without preoperative DEB-TACE. Short-term outcomes and recurrence-free survival (RFS) were compared between the two groups.

RESULTS

After PSM, 44 patients were included in each group. The toxicities of DEB-TACE were mild and could be managed by conservative treatment. Overall response rate (ORR) of conversion therapy (75.0% vs. 81.2%, p = 0.437) and postoperative complication of hepatic resection (27.3% vs. 20.5%, p = 0.453) were similar between the two groups. The median RFS of the DEB-TACE group (10.7 months, 95%CI: 6.6-14.8 months) was significantly longer than that of the control group (8.1 months, 95%CI: 3.4-12.8 months) (HR: 0.60, 95%CI: 0.37-0.95, p = 0.027).

CONCLUSIONS

In patients who became resectable after conversion therapy, preoperative DEB-TACE might be a safe option to achieve longer RFS.

KEY POINTS

• This is a propensity-score matching study comparing patients who underwent conversional hepatectomy with or without preoperative DEB-TACE. • The preoperative DEB-TACE was safe and with mild toxicities (without toxicities more than CTCAE grade 3). • The preoperative DEB-TACE significantly prolonged the RFS of those patients who underwent conversional hepatectomy (10.7 vs. 8.1 months, p = 0.027).

摘要

目的

接受转化治疗后行肝切除术的结直肠癌肝转移（CRLM）患者复发率高达近90%。术前载药微球经动脉化疗栓塞术（DEB-TACE）有可能预防术后复发，但其尚未得到阐明。本研究的目的是评估术前DEB-TACE的安全性和有效性。

材料与方法

收集2016年6月1日至2021年6月30日行肝切除术的CRLM患者，纳入接受转化性肝切除术的患者。将术前接受DEB-TACE的患者与未接受术前DEB-TACE的患者按1:1的比例进行倾向评分匹配。比较两组的短期结局和无复发生存期（RFS）。

结果

倾向评分匹配后，每组纳入44例患者。DEB-TACE的毒性较轻，可通过保守治疗控制。两组间转化治疗的总体缓解率（ORR）（75.0%对81.2%，p = 0.437）和肝切除术后并发症（27.3%对20.5%，p = 0.453）相似。DEB-TACE组的中位RFS（10.7个月，95%CI：6.6 - 14.8个月）显著长于对照组（8.1个月，95%CI：3.4 - 12.8个月）（HR：0.60，95%CI：0.37 - 0.95，p = 0.027）。

结论

在转化治疗后可切除的患者中，术前DEB-TACE可能是实现更长RFS的安全选择。

关键点

• 这是一项倾向评分匹配研究，比较了接受或未接受术前DEB-TACE的转化性肝切除术患者。• 术前DEB-TACE安全，毒性轻微（无超过美国国立癌症研究所常见不良反应事件评价标准3级的毒性）。• 术前DEB-TACE显著延长了接受转化性肝切除术患者的RFS（10.7对8.1个月，p = 0.027）。