Wängberg B, Westberg G, Tylén U, Tisell L, Jansson S, Nilsson O, Johansson V, Scherstén T, Ahlman H
Department of Surgery, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.
World J Surg. 1996 Sep;20(7):892-9; discussion 899. doi: 10.1007/s002689900136.
Sixty-four consecutive patients with disseminated midgut carcinoids were treated during an 8-year period according to a single clinical protocol aimed at aggressive tumor reduction by surgery alone or with subsequent hepatic artery embolization. All patients had markedly elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) levels (581 +/- 79 micromol/24 h) and hormonal symptoms. Fourteen patients (22%) reached anatomic and biochemical cure by surgery alone. At follow-up, the mean 5-HIAA levels were still normal after 69.0 +/- 6. 2 months; two patients had died from unrelated causes. With the introduction of somatostatin receptor scintigraphy, subclinical disease was diagnosed in 7 of these 14 patients. Forty patients with bilobar hepatic disease underwent embolization in combination with octreotide. In this group, 5-HIAA levels were still reduced by 55% after 71 +/- 11 months of follow-up, and the 5-year survival was 56%, estimated from the total death hazard function. After embolization, two subgroups could be identified with marked differences in their long-term response to treatment. Ten patients were not embolized owing to complicating diseases. The 5-year survival for the entire series was 58%. A significantly increased risk of cardiovascular deaths was seen, which underlines the importance of total survival analysis in a disease with multiple hormonal effects. It is concluded that an active surgical approach must be recommended to patients with the midgut carcinoid syndrome. In patients with bilobar hepatic disease, embolization combined with octreotide treatment markedly reduced the 5-HIAA excretion and suggested a prolonged 5-year survival.
在8年期间，根据一项旨在通过单纯手术或随后的肝动脉栓塞积极减少肿瘤的单一临床方案，对64例连续性播散性中肠类癌患者进行了治疗。所有患者的尿5-羟吲哚乙酸（5-HIAA）水平均显著升高（581±79微摩尔/24小时）并有激素症状。14例患者（22%）通过单纯手术达到了解剖学和生化治愈。随访时，69.0±6.2个月后5-HIAA平均水平仍正常；2例患者死于无关原因。随着生长抑素受体闪烁扫描的引入，这14例患者中有7例被诊断为亚临床疾病。40例患有双侧肝病的患者接受了栓塞联合奥曲肽治疗。在该组中，随访71±11个月后5-HIAA水平仍降低55%，根据总死亡风险函数估计5年生存率为56%。栓塞后，可识别出两个亚组，它们对治疗的长期反应有显著差异。10例患者因合并症未接受栓塞治疗。整个系列的5年生存率为58%。观察到心血管死亡风险显著增加，这突出了在一种具有多种激素作用的疾病中进行总生存分析的重要性。结论是，对于中肠类癌综合征患者必须推荐积极的手术方法。对于患有双侧肝病的患者，栓塞联合奥曲肽治疗显著降低了5-HIAA排泄，并提示5年生存率延长。
