小粒径载药微球介入栓塞治疗在肝癌肝移植术前应用的疗效分析

Small diameter DEB-TACE for liver cancer before liver transplantation

目的:探讨小粒径载药微球介入栓塞治疗在肝癌肝移植术前应用的效果和安全性。方法:回顾性分析2018年3月至2019年12月天津市第一中心医院于肝癌肝移植术前接受小粒径载药微球介入栓塞治疗的47例患者临床资料,其中男性39例,女性8例,年龄范围24~70岁,中位年龄51.5岁。统计分析肿瘤大小与数目,随访并发症发生情况,根据改良实体瘤疗效评价标准评价肿瘤反应情况,分析移植等待期间的淘汰率、降期成功率、病理结果以及短期肿瘤复发率。结果:47例肝癌患者中肝功能Child-Pugh A级46例,B级1例。单发肿瘤17例,多发肿瘤30例,肿瘤的最大直径为(30.8±11.7)mm。47例患者共接受50次介入治疗,技术成功率为100.0%。完全缓解率为27.7%(13/47),部分缓解率为51.1%(24/47),疾病稳定率为17.0%(8/47),疾病进展率为4.2%(2/47)。符合米兰标准的肝移植等待患者22例,淘汰率为0;超过米兰标准/加州大学旧金山分校(UCSF)标准接受降期治疗25例,降期至符合UCSF标准的成功率为84.0%(21/25),降期至符合米兰标准的成功率为56.0%(14/25)。接受介入治疗的患者有33例已经接受肝移植,病理结果显示肿瘤坏死率大于50%的比例为78.8%(26/33),肿瘤完全坏死的比例为39.4%(13/33)。无介入相关严重并发症发生。肿瘤复发率为3.0%(1/33)。结论:小粒径载药微球介入栓塞治疗在肝癌肝移植术前应用安全有效,可获得较高的肿瘤坏死率。

Objective To study the short-term safety and efficacy of small diameter drug-eluting beads-transcatheter arterial chemoembolization(DEB-TACE)for patients with liver cancer before liver transplantation.Methods From Mar 2018 to Dec 2019,47 patients underwent small diameter DEB-TACE for liver cancer before liver transplantation.There were 39 males and 8 females,aged 24 to 70 years(median 51.5 years).Analysis of tumor size,tumor number and complications was conducted after DEB-TACE.After DEB-TACE,tumor response evaluation was done according to the modified response evaluation criteria in solid tumors criteria.Ananlyze the elimination rate and downstaged rate during liver transplantation waiting period.For patients who underwent liver transplantation,the pathological findings and the tumor recurrence of patients were analysed.Results There were 46 patients Child-Pugh A,1 patient Child-Pugh B.A solitary liver cancer was found in 17 patients,and multiple tumors in 30 patients.The lesion size was(30.8±17.7)mm.For the 47 patients who together underwent 50 times DEB-TACE.The technical success rate was 100.0%,the complete response rate 27.7%(13/47),partial response rate 51.1%(24/47),stable disease rate 17.0%(8/47),and progressive disease rate 4.2%(2/47).For the 22 patients who met the Milan cirteria and were awaiting for transplantation,the elimination from transplantation rate was 0.For the 25 patients who are beyond the cirteria and who underwent DEB-TACE,84.0%(21/25)of patients were downstaged to within the University of California,San Francisco cirteria and 56.0%(14/25)to within the Milan cirteria.For the 35 patients who underwent liver transplantation,pathology showed that complete necrosis rate was 39.4%(13/33),and more than 50%necrosis was achieved in 26 of 33 patients(78.8%).No significant treatment related complications were observed.Only 3.0%(1/33)of patients suffered from tumor recurrence.Conclusion Small diameter DEB-TACE for liver cancer was an effective procedure with a favorable safety profile and promising results in tumor necrosis rates.