肝动脉栓塞术治疗42例低-中级别乏血供型神经内分泌肿瘤肝转移的近期疗效及安全性分析

Transarterial embolization in the treatment of 42 patients with low-to-intermediate grade neuroendocrine neoplasm liver metastasis with hypovascular pattern:an analysis of the short-term efficacy and safety

目的总结分析低-中级别乏血供型神经内分泌肿瘤肝转移(NENLM)经肝动脉栓塞术(TAE)治疗后的近期疗效及安全性。方法从2016年1月至2019年12月在我院经TAE治疗的不同原发部位的低-中级别NENLM患者中,选取其中术前影像学表现为乏血供型、且术后经影像学复查的42例,分别按照RECIST 1.1和mRECIST标准来评价疗效,分别分析其术后1~3个月客观缓解率(ORR)及疾病控制率(DCR)。术后不良反应分级采用CTCAE (v5.0)标准。结果 TAE治疗对于低-中级别乏血供型NENLM具有显著的减瘤作用,按照RECIST 1.1来评价,ORR为66.7%,DCR为92.9%,按照mRECIST标准来评价,ORR为85.7%,DCR为92.9%,其中CR率为16.7%。不良反应主要为发热(88.1%)、肝区疼痛(78.6%)及肝功能一过性损伤(肝酶升高:40.5%;胆红素升高:19.1%)等,对症处理后均可缓解,无严重术后并发症。结论部分低-中级别NENLM尽管在术前影像学上主要表现为乏血供特征,但是经TAE治疗后ORR显著,TAE是一种安全且有效的减瘤手段。

Objective To summarize and analyse the short-term efficacy and safety of transarterial embolization(TAE)on low-to-intermediate grade neuroendocrine neoplasm liver metastasis(NENLM)with hypovascular pattern.Methods From January 2016 to December 2019,at the First Affiliated Hospital of Sun Yat-sen University,among the patients with different primary site of low-to-intermediate grade NENLM after the treatment of TAE,42 cases were selected whose preoperative imaging findings for lack of blood supply.All cases had completed postoperative imaging evaluation.Respectively according to RECIST 1.1 and mRECIST criteria to evaluate the curative effect,the objective response rate(ORR)and disease control rates(DCR)were calculated within 1-3 months after the operation.Recorded the postoperative adverse events according to Common Terminology Criteria for Adverse Events(CTCAE)v5.0.Results TAE has a significant debulking effect on low-to-intermediate grade NENLM with hypovascular pattern,which was evaluated according to RECIST 1.1,ORR was 66.7%,DCR was 92.9%.And according to mRECIST criteria, ORR was 85.7%, DCR was 92.9%, and CR rate was 16.7%. The major complications were fever(88.1%), hepatic pain (78.6%) and transient liver dysfunction [elevated liver enzymes (40.5%), elevatedbilirubin (19.1%)], which can be alleviated after symptomatic treatment. There is no serious postoperativecomplications. Conclusions Although some low-to-intermediate grade NENLM is characterized by lack ofblood supply in imaging, its ORR is still significant after TAE. TAE is safe and effective in reducing burden inNENLM with hypovascular pattern.