肝动脉栓塞术治疗神经内分泌肿瘤肝转移患者的疗效、预后和影响因素分析

Efficacy,prognosis and influencing factors of transcatheter arterial embolization in the treatment of neuroendocrine neoplasm liver metastases

目的评估肝动脉栓塞术(TAE)治疗神经内分泌肿瘤肝转移(NENLM)患者的疗效,分析患者预后及影响因素。方法回顾性分析2018年1月至2022年3月在南京医科大学第一附属医院接受TAE治疗的NENLM患者的临床资料,根据实体瘤反应评价标准及不良事件通用术语标准评价TAE术后客观缓解率(ORR)、疾病控制率(DCR)及不良事件发生率,用中位总生存期(mOS)、中位无进展生存期(mPFS)评价患者预后,采用Kaplan-Meier法绘制生存曲线;多因素Cox回归分析预后的影响因素。结果共纳入39例NENLM患者,年龄(53.3±10.3)岁(23~74岁),男23例,女16例。其中9例为功能性神经内分泌肿瘤。原发部位位于消化系统的有31例,原发灶WHO分级为G1、G2级的共有32例。肝转移瘤血供丰富者有27例,13例患者肝肿瘤负荷>50%。30例患者联合长效生长抑素类似物(SSA)治疗。39例患者共行123次TAE,ORR为38.5%(15/39),DCR为76.9%(30/39)。围手术期无4~5级严重不良事件发生。中位随访时间38.7(95%CI:31.3~46.1)个月,mOS为37.3(95%CI:27.0~47.5)个月,mPFS为12.6(95%CI:7.1~18.1)个月。多因素Cox回归分析发现,联合长效SSA治疗是患者总生存期长的影响因素(HR=0.207,95%CI:0.076~0.567,P=0.002)。结论TAE能有效降低NENLM患者肝转移瘤负荷,联合长效SSA治疗可提高患者的总生存期。

Objective To evaluate the efficacy of transcatheter arterial embolization(TAE)in the treatment of neuroendocrine neoplasm liver metastases(NENLM),analyze the prognosis and related factors.Methods Clinical data of NENLM patients treated with TAE in the First Affiliated Hospital of Nanjing Medical University from January 2018 to March 2022 were retrospectively analyzed.Objective response rate(ORR),disease control rate(DCR),and adverse event rate after TAE were evaluated according to the Response Evaluation Criteria In Solid Tumors and the Common Terminology Criteria for Adverse Events.The prognosis was evaluated by median overall survival(mOS)and median progression-free survival(mPFS).The survival curve was plotted by Kaplan-Meier method.Multivariate Cox regression was used to analyze prognostic factors.Results A total of 39 NENLM patients were included in this study,aged(53.3±10.3)(23-74)years old,including 23 males and 16 females.Among them,9 cases had functional neuroendocrine neoplasms.There were 31 cases with primary sites locating in the digestive system,32 cases with WHO G1 and G2 primary sites,27 cases with abundant blood supply for liver metastases and 13 cases with liver tumor load>50%.Thirty patients received treatment of long-acting somatostatin analogue(SSA).A total of 123 TAE were performed in 39 cases,with an ORR of 38.5%(15/39)and a DCR of 76.9%(30/39).There were no serious adverse events of level 4-5 during the perioperative period.The median follow-up was 38.7(95%CI:31.3-46.1)months,with mOS of 37.3(95%CI:27.0-47.5)months and mPFS of 12.6(95%CI:7.1-18.1)months.Multivariate Cox regression analysis found that the combination of long-term SSA treatment was an influencing factor for overall survival of patients(HR=0.207,95%CI:0.076-0.567,P=0.002).Conclusions TAE can effectively reduce the load of liver metastases in patients with NENLM,and the combination of long-term SSA treatment can improve the ovreall survival of patients.