药物洗脱微球栓塞治疗肝癌合并肝动脉-门静脉瘘

Drug-eluting beads in the treatment of hepatocellular carcinoma with hepatic arterio-portal shunt

目的探讨药物洗脱微球(DEB)栓塞治疗肝细胞癌(HCC)合并肝动脉-门静脉瘘(HAPS)的安全性及有效性。方法回顾性分析26例HCC合并HAPS行DEB栓塞治疗患者的临床资料:肝功能水平包括术前血清白蛋白水平、腹水、Child-Pugh分级,HAPS的影像表现,随访并记录生存期、肿瘤治疗后反应。根据HAPS程度分4级,采用Kaplan-Meier法计算累积生存率,生存预测因素采用Cox模型分析。根据改良的实体瘤疗效评价标准(mRECIST)计算肿瘤治疗反应。结果总人群的中位生存期为310 d,1级瘘组为261 d,2级瘘组为333 d,3级瘘组为250 d。采用KaplanMeier法估计,三组HAPS患者的生存曲线差异无统计学意义(P=0. 456)。在整个研究人群中,6、12和24个月的生存率分别为76. 9%,37. 3%和12. 4%。术前血清白蛋白水平(P=0. 005,风险比=0. 712,95%可信区间0. 560,0. 904),有无腹水(P=0. 028,风险比=9. 848,95%可信区间1. 284,75. 533),术前Child-Pugh分级(P=0. 032,风险比=0. 082,95%可信区间0. 008,0. 802)是潜在的预测因素。结论 DEB栓塞治疗是一种安全有效治疗HCC合并HAPS的方法,术前肝功能水平是患者预后的预测因素。

Objective To investigate the safety and efficiency of drug-eluting beads (DEB) in the treatment of hepatocellular carcinoma (HCC) with hepatic arterio-portal shunt (HAPS). Methods 26 HCC patients with HAPS who underwent DEB-TACE (transcatheter arterial chemoembolization) were included in this retrospective study. Liver function level included preoperative serum albumin level, ascites, Child-Pugh classification, imaging manifestations of HAPS, follow-up and record survival time and response to cancer treatment.According to the degree of HAPS, all the patients were divided into 4 groups. After performing Kaplan-Meier, survival rate was calculated. Tumor response was measured by mRECIST criteria. Results The median survivals were 310 days, 261 days, 333 days, and 250 days in the entire study population, group 1, group 2, and group 3, respectively. There was no statistical significance in the survival curve among three groups (P=0.456). In the entire study population, the survival rates were 76.9%, 37.3%, and 12.4% at 6 months, 12 months, and 24 months, respectively. After performing proportional hazards model, the preoperative serum albumin level, presence or absence of ascites, and preoperative Child-Pugh classification were independent predict factors for prognosis. Conclusions DEB-TACE is a safe and effective treatment for HCC with HAPS. The preoperative liver function is essential for patients' prognosis.