DEM-TACE 作为初始治疗可提高伴有门静脉癌栓的肝细胞癌的临床疗效：一项回顾性对照研究。
DEM-TACE as the initial treatment could improve the clinical efficacy of the hepatocellular carcinoma with portal vein tumor thrombus: a retrospective controlled study.
机构信息
Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road 600#, Tianhe District, Guangzhou, 510630, Guangdong, China.
Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510030, China.
出版信息
BMC Cancer. 2022 Nov 30;22(1):1242. doi: 10.1186/s12885-022-10361-5.
BACKGROUND
Conventional-transarterial chemoembolization (C-TACE) was proven to improve overall survival (OS) in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT), drug-eluting microsphere-TACE (DEM-TACE) was supposed to provide more benefit than C-TACE in this respect.
PURPOSE
To compare the safety and efficacy between DEM-TACE and C-TACE as the initial treatment in HCC patients with PVTT and to identify prognostic factors of OS.
METHODS
The medical records of advanced HCC patients with PVTT who underwent DEM-TACE or C-TACE as the initial thearpy from September 2015 with mean follow-up time 14.9 ± 1.2 (95% CI 12.6-17.2) months were retrospectively evaluated. A total of 97 patients were included, 49 patients in the DEM-TACE group and 48 in the C-TACE group. Adverse events (AEs) related to TACE were compared. Tumor and PVTT radiologic response, time to tumor progression (TTP) and OS were calculated and compared in both groups.
RESULTS
Patients in DEM-TACE group had a better radiologic response (Tumr response: 89.8% vs. 75.0%; PVTT response: 85.7% vs. 70.8%; overall response: 79.6% vs. 58.3%, P = 0.024) and longer TTP (7.0 months vs. 4.0 months, P = 0.040) than patients in C-TACE group. A lower incidence of abdominal pain was found in the DEM-TACE group than in C-TACE group (21 vs. 31, P = 0.032), but there were no significant differences between DEM-TACE and C-TACE patients in any other AEs reported. When compared to C-TACE, DEM-TACE also showed significant OS benefits (12.0 months vs. 9.0 months, P = 0.027). DEM-TACE treatment, the absence of arterioportal shunt (APS), lower AFP value and better PVTT radiologic response were the independent prognostic factors for OS in univariate/multivariate analyses, which provided us with a guide for better patient selection.
CONCLUSIONS
Based on our retrospective study, DEM-TACE can be performed safely and might be superior to C-TACE as the initial treatment for HCC patients with PVTT.
TRIAL REGISTRATION
Retrospectively registered.
背景
常规经动脉化疗栓塞术（C-TACE）已被证明可改善伴门静脉癌栓（PVTT）的肝细胞癌（HCC）患者的总生存期（OS），载药微球 TACE（DEM-TACE）在这方面可能比 C-TACE 更具优势。
目的
比较 DEM-TACE 和 C-TACE 作为 HCC 伴 PVTT 患者初始治疗的安全性和疗效，并确定 OS 的预后因素。
方法
回顾性分析 2015 年 9 月至 2015 年 9 月期间接受 DEM-TACE 或 C-TACE 作为初始治疗的进展期 HCC 伴 PVTT 患者的病历资料，中位随访时间为 14.9±1.2 个月（95%CI 12.6-17.2）。共纳入 97 例患者，其中 DEM-TACE 组 49 例，C-TACE 组 48 例。比较两组 TACE 相关不良事件（AEs）。比较两组肿瘤和 PVTT 的影像学反应、肿瘤进展时间（TTP）和 OS。
结果
DEM-TACE 组患者的影像学反应（肿瘤反应：89.8%比 75.0%；PVTT 反应：85.7%比 70.8%；总体反应：79.6%比 58.3%，P=0.024）和 TTP 更长（7.0 个月比 4.0 个月，P=0.040）。DEM-TACE 组患者腹痛发生率低于 C-TACE 组（21 比 31，P=0.032），但两组报告的其他任何 AEs 发生率均无显著差异。与 C-TACE 相比，DEM-TACE 也显示出显著的 OS 获益（12.0 个月比 9.0 个月，P=0.027）。单因素/多因素分析显示，DEM-TACE 治疗、无动静脉分流（APS）、较低的 AFP 值和更好的 PVTT 影像学反应是 OS 的独立预后因素，这为我们提供了更好的患者选择指导。
结论
基于我们的回顾性研究，DEM-TACE 是安全可行的，可能优于 C-TACE，作为 HCC 伴 PVTT 患者的初始治疗方法。
试验注册
回顾性注册。
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