肝动脉栓塞术联合长效奥曲肽降低中低级别神经内分泌瘤肝转移负荷的疗效及安全性分析

Safety and efficacy of transarterial embolization combined with octreotide LAR on reducing tumor burden for neuroendocrine tumor liver metastasis

目的探讨肝动脉栓塞术(TAE)联合长效奥曲肽对中低级别神经内分泌瘤肝转移(NETLM)的疗效及安全性。方法回顾性分析2014年10月至2018年8月中山大学附属第一医院诊治的29例NETLM患者,年龄25~69(50±11)岁,男12例、女17例。所有病例均病理确诊,病例资料完整。其中17例TAE联合长效奥曲肽(联合治疗组),12例单纯长效奥曲肽治疗(单纯治疗组)。根据实体瘤反应评价标准1.1(RECIST 1.1)评价肝内病灶疗效,比较两组客观反应率(ORR),并评价其安全性。结果联合治疗组部分缓解13例,病情稳定4例;单纯治疗组部分缓解1例,病情稳定9例,疾病进展2例。两组ORR差异有统计学意义(13/17比1/12,P<0.01)。TAE术后主要不良反应为栓塞后综合征,包括腹痛(12/17)、呕吐(6/17)、发热(4/17)、转氨酶升高(8/17)及胆红素升高(3/17)等。1例患者出现肿瘤溶解综合征。结论相比单纯应用长效奥曲肽,TAE联合长效奥曲肽更有效降低NET肝转移肿瘤负荷,并具有良好的安全性和耐受性。

Objective To evaluate the tumor burden reducing efficacy and safety of transcatheter arterial embolization (TAE) combined with octreotide LAR on neuroendocrine tumor liver metastasis (NETLM). Methods Twenty-nine NETLM patients treated in the First Affiliated Hospital of Sun Yat-sen University from October 2014 to August 2018 were retrospectively recruited, including 12 males and 17 females. The mean age was 25-69(50±11) years. All patients were histologically proved as well-differentiated NET liver metastasis. Seventeen patients underwent combined treatment of TAE plus octreotide LAR (combined group) and 12 patients treated with only octreotide LAR (control group). Response of hepatic lesions were assessed according to RECIST 1.1. Objective response rates (ORR) of two groups were compared and analyzed. Safety and tolerance to TAE were also evaluated. Results There were 13 PR and 4 SD in combined group, but only 1 PR and 9 PD in the control group. The ORR between the two groups were significantly different (13/17 vs 1/12, P<0.01).The main complication post TAE was post embolization syndrome, including abdominal pain (12/17), vomiting (6/17), fever (4/17), elevated transaminase (8/17) and bilirubinemia (3/17). Tumor lysis syndrome was observed in one patient. Conclusion Compared to administration of octreotide LAR, TAE combined with octreotide LAR can effectively reduce tumor burden in patients with NETLM. TAE is safe and well-tolerated.