传统TACE与DEB-TACE治疗不可切除肝细胞癌患者的短期疗效和安全性比较

Comparison of efficacy and safety of TACE and DEB-TACE in treatment of patients with unresectable hepatocellular carcinoma

目的:比较传统经导管肝动脉化疗栓塞(TACE)与载药微球经导管肝动脉化疗栓塞(DEB-TACE)治疗不可切除肝细胞癌患者的短期疗效及安全性。方法:回顾分析2019年7月至2020年4月在宁夏医科大学总医院行肝动脉化疗栓塞的不可切除肝细胞癌患者资料。共入组282例患者,其中男性233例,女性49例,年龄(55.9±10.0)岁。按照治疗不同分为传统TACE组(n=179)和DEB-TACE组(n=103)。依据改良实体瘤临床疗效评价标准比较两组疗效。比较两组术前术后肝功能指标、栓塞后综合征。结果:两组肝动脉化疗栓塞患者术前、术后肝功能指标比较,差异均无统计学意义(均P>0.05)。排除术后6个月内死亡和失访患者,共240例患者纳入疗效分析,其中传统TACE组148例,DEB-TACE组92例。术后6个月评估疗效,传统TACE组完全缓解64例(43.2%)、部分缓解18例(12.2%)、疾病稳定27例(18.2%)、疾病进展39例(26.4%),DEB-TACE组分别为38例(41.3%)、17例(18.5%)、26例(28.3%)、11例(12.0%),DEB-TACE疗效优于传统TACE,差异有统计学意义(χ^(2)=8.96,P=0.030)。传统TACE组术后栓塞后综合征发生率53.1%(95/179),高于DEB-TACE组的34.0%(35/103),差异有统计学意义(χ^(2)=7.34,P=0.007)。结论:DEB-TACE治疗不可切除肝细胞癌的短期疗效及安全性优于传统TACE。

Objective To compare the clinical efficacy and safety of conventional transcatheter arterial chemoembolization(TACE)with drug-eluting bead transcatheter arterial chemoembolization(DEB-TACE)in treatment of patients with unresectable hepatocellular carcinoma.Methods The data of patients with unresectable hepatocellular carcinoma who underwent hepatic artery chemoembolization at General Hospital of Ningxia Medical University from July 2019 to April 2020 were retrospectively analyzed.Of 282 patients who were enrolled,there were 233 males and 49 females,aged(55.9±10.0)years.The groups were divided into the conventional TACE group(n=179)and the DEB-TACE group(n=103)based on the treatments.The efficacy of the two groups was compared according to the modified response evaluation criteria in solid tumors.Postoperative adverse effects and liver function between the two groups were compared.Results The differences in comparing the preoperative and postoperative liver function indexes between the two groups were not statistically significant.Patients who died and were lost to follow-up at 6 months after surgery were excluded and 240 patients were excluded in the efficacy analysis,with 148 patients in the conventional TACE group and 92 patients in the DEB-TACE group.At 6 months after treatment in the conventional TACE group,there were 64 patients(43.2%)with complete remission,18 patients(12.2%)with partial remission,27 patients(18.2%)with stable disease,and 39 patients(26.4%)with disease progression.In the DEB-TACE group,the corresponding figures were 38 patients(41.3%),17 patients(18.5%),26 patients(28.3%),and 11 patients(12.0%),respectively.The efficacy of DEB-TACE was better than conventional TACE with statistically significant differences between the 2 groups(χ^(2)=8.96,P=0.030).The incidence of postoperative embolic syndrome was 53.1%(95/179)in the conventional TACE group,which was significantly higher than the 34.0%(35/103)in the DEB-TACE group(χ^(2)=7.34,P=0.007).Conclusion The efficacy and safety of DEB-TACE for unresectable hepatocellular carcinoma were superior to those of the conventional TACE group.