Meyblum Louis, Faron Matthieu, Deschamps Frédéric, Kobe Adrian, Bonnet Baptiste, Boileve Alice, Gelli Maximilliano, Boige Valérie, Hollebecque Antoine, Durand-Labrunie Jerome, Malka David, Barbé Remy, Ducreux Michel, de Baere Thierry, Tselikas Lambros
Département d'Anesthésie, Chirurgie et Interventionnel (DACI), Service de Radiologie Interventionnelle, Gustave Roussy, Villejuif, F-94805, France.
OncoStat (U1018), Inserm, Université Paris Saclay, Gustave Roussy, Villejuif, F-94805, France.
Eur Radiol. 2025 Feb;35(2):1022-1033. doi: 10.1007/s00330-024-10887-1. Epub 2024 Jul 30.
Approximately 40% of patients with colorectal cancer will develop liver metastases. Hepatic arterial infusion chemotherapy (HAIC) represents a valuable treatment option, with curative, palliative, or adjuvant intent. The aim of our study was to describe technical considerations, safety, and oncological outcomes of patients receiving HAIC.
All patients who underwent percutaneous hepatic arterial port placement in our institution between 2004 and 2021 were included in this retrospective analysis. Demographic, anatomical and technical data were collected. Tumor response was assessed using RECIST 1.1. Kaplan-Meier estimates were used for overall survival (OS) and hepatic progression-free survival (PFS). Adverse events (AEs) were graded using the Clavien-Dindo classification.
A total of 360 patients (median age, 58.6 years [interquartile range (IQR): 49.5-65.4]; 208 men [57.8%]) were included. Percutaneous hepatic arterial port placement was successful in 87.9% of cases, resulting in 379 port placements (431 attempts). Overall, 394 HAIC courses were delivered, mostly oxaliplatin-based (94.7%), with a median of 6 cycles per course (IQR: 3-8). AEs (all grades) were observed in 42.0% of ports (grade IIIb-V: 1.1%). Most port dysfunctions could be resolved, resulting in a 73.1% rate of HAIC resumption, without impact on OS. Median OS was 22 months (IQR: 18-24), and median hepatic PFS was 11 months (IQR: 9.5-13). Tumor downstaging allowed surgery in 35.6% of patients, with significantly longer median OS than non-operated patients (39 months [IQR: 33-79] versus 14 months [IQR: 12-16], p < 0.001).
This retrospective cohort study demonstrates the feasibility, safety, and efficacy of percutaneous hepatic arterial port placement with an impact on survival for selected patients.
Percutaneous hepatic arterial port placement is feasible, safe and effective with an impact on the survival of selected patients.
Hepatic arterial infusion chemotherapy provides promising tumor response and overall survival, especially in cases of resection/ablation. Total complication rate of hepatic arterial infusion chemotherapy port use is high, but serious complications are rare. Port revision is often necessary but allows the resumption of hepatic arterial infusion chemotherapy without affecting overall survival.
约40%的结直肠癌患者会发生肝转移。肝动脉灌注化疗（HAIC）是一种有价值的治疗选择，具有根治性、姑息性或辅助性治疗目的。本研究的目的是描述接受HAIC治疗的患者的技术要点、安全性和肿瘤学结局。
本回顾性分析纳入了2004年至2021年期间在我院接受经皮肝动脉置管的所有患者。收集了人口统计学、解剖学和技术数据。使用RECIST 1.1评估肿瘤反应。采用Kaplan-Meier法估计总生存期（OS）和无肝进展生存期（PFS）。不良事件（AE）按照Clavien-Dindo分类法进行分级。
共纳入360例患者（中位年龄58.6岁[四分位间距（IQR）：49.5 - 65.4]；男性208例[57.8%]）。经皮肝动脉置管成功率为87.9%，共进行了379次置管（431次尝试）。总体而言，共进行了394个疗程的HAIC，大多数以奥沙利铂为基础（94.7%），每个疗程中位为6个周期（IQR：3 - 8）。42.0%的置管观察到AE（所有级别）（IIIb - V级：1.1%）。大多数置管功能障碍可以解决，HAIC恢复率为73.1%，且对OS无影响。中位OS为22个月（IQR：18 - 24），中位无肝PFS为11个月（IQR：9.5 - 13）。肿瘤降期使35.6%的患者能够接受手术，其术后中位OS明显长于未手术患者（39个月[IQR：33 - 79]对14个月[IQR：12 - 16]，p < 0.001）。
这项回顾性队列研究证明了经皮肝动脉置管的可行性、安全性和有效性，对部分患者的生存有影响。
经皮肝动脉置管可行、安全且有效，对部分患者的生存有影响。
肝动脉灌注化疗可提供有前景的肿瘤反应和总生存期，尤其是在切除/消融病例中。肝动脉灌注化疗置管的总并发症发生率较高，但严重并发症罕见。通常需要进行置管修复，但可在不影响总生存期的情况下恢复肝动脉灌注化疗。
