Cheng Xiao-Bo, Yang Li, Lu Ming-Qian, Peng Yi-Bo, Wang Lei, Zhu Shuang-Ming, Hu Zhi-Wei, Wang Zhong-Liang, Yang Qin
Department of Oncology, Dangyang People's Hospital, Dangyang 444100, Hubei Province, China.
Department of Oncology, Yichang Central People's Hospital (The First Clinical Medical School of China Three Gorges University), Yichang 443008, Hubei Province, China.
World J Gastrointest Surg. 2024 Nov 27;16(11):3463-3470. doi: 10.4240/wjgs.v16.i11.3463.
Transcatheter arterial chemoembolization (TACE) is the main treatment for patients with primary hepatocellular carcinoma (PHC) who miss the opportunity to undergo surgery. Conventional TACE (c-TACE) uses iodized oil as an embolic agent, which is easily washed by blood and affects its efficacy. Drug-eluting bead TACE (DEB-TACE) can sustainably release chemotherapeutic drugs and has a long embolization time. However, the clinical characteristics of patients before the two types of interventional therapies may differ, possibly affecting the conclusion. Only a few studies have compared these two interventions using propensity-score matching (PSM).
To analyze the clinical effects of DEB-TACE and c-TACE on patients with PHC based on PSM.
Patients with PHC admitted to Dangyang People's Hospital (March 2020 to March 2024) were retrospectively enrolled and categorized into groups A (DEB-TACE, = 125) and B (c-TACE, = 106). Sex, age, Child-Pugh grade, tumor-node-metastasis stage, and Eastern Cooperative Oncology Group score were selected for 1:1 PSM. Eighty-six patients each were included post-matching. Clinical efficacy, liver function indices (aspartate aminotransferase, alanine aminotransferase, total bilirubin, and albumin), tumor serum markers, and adverse reactions were compared between the groups.
The objective response and disease control rates were significantly higher in group A (80.23% and 97.67%, respectively) than in group B (60.47% and 87.21%, respectively) ( < 0.05). Post-treatment levels of aspartate aminotransferase, alanine aminotransferase, and total bilirubin were lower in group A than in group B ( < 0.05), whereas post-treatment levels of albumin in group A were comparable to those in group B ( > 0.05). Post-treatment levels of tumor serum markers were significantly lower in group A than in group B ( < 0.05). Patients in groups A and B had mild-to-moderate fever and vomiting symptoms, which improved with conservative treatment. The total incidence of adverse reactions was significantly higher in group B (22.09%) than in group A (6.97%) ( < 0.05).
DEB-TACE has obvious therapeutic effects on patients with PHC. It can improve liver function indices and tumor markers of patients without increasing the rate of liver toxicity or adverse reactions.
经动脉化疗栓塞术（TACE）是错失手术机会的原发性肝细胞癌（PHC）患者的主要治疗方法。传统TACE（c-TACE）使用碘化油作为栓塞剂，其易被血流冲走，影响疗效。载药微球TACE（DEB-TACE）能持续释放化疗药物，栓塞时间长。然而，两种介入治疗前患者的临床特征可能不同，可能影响结论。仅有少数研究采用倾向评分匹配（PSM）比较这两种干预措施。
基于PSM分析DEB-TACE和c-TACE对PHC患者的临床疗效。
回顾性纳入2020年3月至2024年3月在当阳市人民医院收治的PHC患者，分为A组（DEB-TACE，n = 125）和B组（c-TACE，n = 106）。选择性别、年龄、Child-Pugh分级、肿瘤-淋巴结-转移分期和东部肿瘤协作组评分进行1:1 PSM。匹配后每组纳入86例患者。比较两组的临床疗效、肝功能指标（天冬氨酸转氨酶、丙氨酸转氨酶、总胆红素和白蛋白）、肿瘤血清标志物及不良反应。
A组的客观缓解率和疾病控制率显著高于B组（分别为80.23%和97.67% vs 60.47%和87.21%）（P < 0.05）。A组治疗后天冬氨酸转氨酶、丙氨酸转氨酶和总胆红素水平低于B组（P < 0.05），而A组治疗后白蛋白水平与B组相当（P > 0.05）。A组治疗后肿瘤血清标志物水平显著低于B组（P < 0.05）。A组和B组患者均有轻至中度发热和呕吐症状，经保守治疗后好转。B组不良反应总发生率显著高于A组（22.09% vs 6.97%）（P < 0.05）。
DEB-TACE对PHC患者有明显治疗效果。它可改善患者的肝功能指标和肿瘤标志物，且不增加肝毒性或不良反应发生率。
