Ⅲa期乏血供肝癌DEB-TACE综合介入治疗11例

Eleven cases of DEB-TACE comprehensive interventional strategy for stage Ⅲ a hypovascular hepatocellular carcinoma

目的:探讨门静脉支架联合^(125)I粒子条植入、载药微球经肝动脉化疗栓塞术(drug-eluting beads transarterial chemoembolization,DEB-TACE)及分子靶向药物综合治疗Ⅲa期乏血供肝细胞癌(hepatocellular carcinoma,HCC)伴门静脉癌栓(portal vein tumor thrombus,PVTT)的安全性和有效性。方法:回顾性分析2016年11月至2018年10月于华中科持大学同济医学院附属协和医院11例确诊为Ⅲa期乏血供HCC伴PVTT 11例患者,行门静脉支架联合^(125)I粒子条植入后序贯使用载药微球经肝动脉化学栓塞术(DEB-TACE)及分子靶向药物综合治疗。随访期间,评估所有患者治疗后支架通畅情况及DEB-TACE治疗后的肿瘤反应,比较术前、术后1个月的肝功能、血常规的变化并总结并发症的发生情况。结果:根据原发性肝癌诊疗规范(2017年版)11例患者均为Ⅲa期,Child-Pugh A、B级,影像学提示为乏血供肝癌,最大径为8.4±4.1(2.8～14.1)cm,均伴有PVTT,其中程氏分型Ⅱ型者4例,Ⅲ型者7例;门静脉主干癌栓≥50%者6例,<50%者1例。所有患者顺利进行^(125)I粒子支架门静脉内植入联合DEB-TACE治疗。支架植入后3个月、6个月通畅率均为100%;DEB-TACE治疗后3个月完全缓解(complete response,CR)患者4例(36.4%),部分缓解(partial response,PR)患者5例(45.5%),疾病稳定(stable disease,SD)患者2例(18.2%),PD患者0例。客观反应率(objective response rate,ORR)为81.8%,疾病控制率(disease control rate,DCR)为100%。肝肾功能、血常规等指标术前与术后1个月差异无统计学意义,11例患者在围手术期过程中未出现严重并发症。结论:门静脉支架联合^(125)I粒子条植入序贯使用载药微球经肝动脉化学栓塞术(DEB-TACE)及分子靶向药物,综合治疗Ⅲa期乏血供HCC伴PVTT可以恢复门脉主干血流并保持中长期通畅,同时较理想地杀灭肿瘤及控制肿瘤生长,是安全有效的治疗策略。

Objective: To evaluate the efficacy and safety of portal vein stenting combined with125 I particle strand implantation followed by drug-eluting beads transarterial chemoembolization(DEB-TACE) and molecular-targeted therapy for the treatment of stage Ⅲa liver cancer lacking a blood supply. Methods: A retrospective analysis of 11 patients who had stage Ⅲa liver cancer lacking a blood supply combined with portal vein tumor thrombosis(PVTT) was conducted from October 2016 to October 2018. All the patients underwent portal vein stenting combined with125 I particle strand implantation, DEB-TACE, and comprehensive treatment containing molecular-targeted drugs. During the follow-up period, all patients were evaluated for stent patency after the implantation and tumor response after DEB-TACE treatment. The liver function and blood routine changes before and 1 month after the surgery were completed,and the complications were summarized. Results: All 11 patients were judged as stage Ⅲa liver cancer based on the Chinese staging criteria(2017), Child-Pugh classification grade A and B. The imaging findings indicated that these tumors were hypovascular. The maximum diameter of these lesions was(8.4 ± 4.1)(2.8-14.1) cm, and all patients had PVTT. Among them, there were 4 cases of Cheng’s type Ⅱ and 7 cases of type Ⅲ: 6 cases of main PVTT ≥50% and 1 case of PVTT <50%. All patients underwent portal vein stenting combined with125 I particle strand implantation, DEB-TACE, and comprehensive treatment containing molecular-targeted drugs. Three and6 months after stent implantation, the patency rate was 100%;3 months after DEB-TACE treatment, complete response was achieved in 4(36.4%) patients, partial response was achieved in 5(45.5%) patients, and stable disease was achieved in 2(18.2%) patients. No patients exhibited progressive disease. Therefore, the objective response rate was 81.8% and disease control rate was 100%. As for the liver and kidney function and blood routine tests, there were no significant differences between baseline and 1 month after the surgery. In addition, no patient had any serious complication during the perioperative period. Conclusions: For patients with stage Ⅲa liver cancer lacking a blood supply and PVTT, a comprehensive treatment strategy including portal vein stenting combined with125 I particle strand implantation, DEB-TACE, and molecular-targeted therapy can restore portal vein blood flow and maintain mid-and longterm stent patency, while effectively killing tumors and controlling tumor growth, which is a safe and effective treatment strategy.