Wängberg B, Geterud K, Nilsson O, Jansson S, Dahlström A, Tylén U, Ahlman H
Department of Surgery, University of Göteborg, Sweden.
Acta Oncol. 1993;32(2):251-6. doi: 10.3109/02841869309083921.
Forty-eight patients with midgut carcinoid tumours and disseminated disease were treated at our unit 1986-1991. All patients underwent primary surgery with optimal tumour reduction. Twenty-seven patients with bilobar liver metastases had subsequent embolizations of the hepatic arteries to further reduce the functional tumour mass and were thereafter treated with a low dose of octreotide. The response to this treatment was evaluated by CT at 3 months postembolization. The patients could then be divided into 13 responders (no visible hepatic tumours or more than 50% reduction, group I) and 14 non-responders (less than 50 reduction or progression, group II). When these patients were studied biochemically and in terms of prognosis, the reduction of 5-HIAA levels postembolization was much more pronounced in group I (80 +/- 3%) then in group II (28 +/- 12%). The biochemical and radiological responses were long-lasting in group I, none of the patients needed further ischaemic treatment. Of specific interest were 3 patients with bilobar disease, who after selective unilobar embolisation normalised their 5-HIAA levels and had bilateral tumour regression. These findings indicate involvement of systemic effects in addition to tumour ischaemia alone. The initial biochemical response with marked decrease of 5-HIAA levels in combination with tumour regression may thus serve as an indicator of good prognosis.
1986年至1991年期间，我们科室对48例患有中肠类癌肿瘤并伴有播散性疾病的患者进行了治疗。所有患者均接受了旨在最大程度减少肿瘤的初次手术。27例患有双侧肝转移的患者随后接受了肝动脉栓塞，以进一步减少功能性肿瘤体积，之后接受低剂量奥曲肽治疗。栓塞后3个月通过CT评估该治疗的反应。然后这些患者可分为13例反应者（无可见肝肿瘤或缩小超过50%，第一组）和14例无反应者（缩小不到50%或病情进展，第二组）。当对这些患者进行生化和预后研究时，栓塞后第一组5-羟吲哚乙酸（5-HIAA）水平的降低（80±3%）比第二组（28±12%）更为明显。第一组的生化和放射学反应持久，没有患者需要进一步的缺血治疗。特别值得关注的是3例患有双侧疾病的患者，他们在选择性单侧叶栓塞后5-HIAA水平恢复正常，双侧肿瘤缩小。这些发现表明除了肿瘤缺血外还涉及全身效应。5-HIAA水平显著降低并伴有肿瘤缩小的初始生化反应因此可能作为预后良好的指标。
