Wang Fuquan, Chen Lei, Bin Chai, Cao Yanyan, Wang Jihua, Zhou Guofeng, Zheng Chuansheng
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China.
Front Oncol. 2024 Apr 24;14:1338293. doi: 10.3389/fonc.2024.1338293. eCollection 2024.
The purpose of this retrospective study was to compare the therapeutic efficacy and safety of drug-eluting bead transarterial chemoembolization (DEB-TACE) combined with systemic therapy to systemic therapy alone as first-line treatment for unresectable patients with colorectal liver metastases (CRLM).
From December 2017 to December 2022, patients with unresectable CRLM who received systemic therapy with or without DEB-TACE as first-line treatment were included in the study. The primary endpoint was progression-free survival (PFS). Secondary endpoints were tumor response, conversion rate and adverse events.
Ninety-eight patients were enrolled in this study, including 46 patients who received systemic therapy combined with DEB-TACE (DEB-TACE group) and 52 patients who received systemic therapy alone (control group). The median PFS was elevated in the DEB-TACE group compared with the control group (12.1 months vs 8.4 months, = 0.008). The disease control rate was increased in the DEB-TACE group compared with the control group (87.0% vs 67.3%, = 0.022). Overall response rates (39.1% vs 25.0%; = 0.133) and conversion rate to liver resection (33.8% vs 25.0%; = 0.290) were no different between the two groups. The multivariate analysis showed that treatment options, size of liver metastasis, number of liver metastasis, synchronous metastases, and extrahepatic metastases were independent prognostic factor of PFS. Further subgroup analyses illustrated that PFS was beneficial with the DEB-TACE group in patients with age ≥ 60, male, left colon, synchronous metastases, bilobar, number of liver metastasis > 5, extrahepatic metastases, non-extrahepatic metastases, CEA level < 5 (ng/ml), and KRAS wild-type. No grade 4 or 5 toxicities related to DEB-TACE procedures were observed.
In patients with unresectable CRLM, systemic chemotherapy with DEB-TACE as first-line treatment may improve progression-free survival and disease control rate outcomes over systemic chemotherapy alone with manageable safety profile.
本回顾性研究旨在比较药物洗脱微球经动脉化疗栓塞术（DEB-TACE）联合全身治疗与单纯全身治疗作为不可切除结直肠癌肝转移（CRLM）患者一线治疗的疗效和安全性。
2017年12月至2022年12月，纳入接受一线治疗（有或无DEB-TACE）的不可切除CRLM患者。主要终点是无进展生存期（PFS）。次要终点是肿瘤反应、转化率和不良事件。
本研究共纳入98例患者，其中46例接受全身治疗联合DEB-TACE（DEB-TACE组），52例接受单纯全身治疗（对照组）。与对照组相比，DEB-TACE组的中位PFS有所提高（12.1个月对8.4个月，P = 0.008）。与对照组相比，DEB-TACE组的疾病控制率有所提高（87.0%对67.3%，P = 0.022）。两组的总缓解率（39.1%对25.0%；P = 0.133）和肝切除转化率（33.8%对25.0%；P = 0.290）无差异。多因素分析显示，治疗方案、肝转移瘤大小、肝转移瘤数量、同时性转移和肝外转移是PFS的独立预后因素。进一步的亚组分析表明，对于年龄≥60岁、男性、左半结肠、同时性转移、双叶、肝转移瘤数量>5、肝外转移、无肝外转移、癌胚抗原（CEA）水平<5（ng/ml）和KRAS野生型的患者，DEB-TACE组的PFS更有益。未观察到与DEB-TACE操作相关的4级或5级毒性反应。
对于不可切除的CRLM患者，以DEB-TACE作为一线治疗的全身化疗可能比单纯全身化疗更能改善无进展生存期和疾病控制率，且安全性可控。
