载药微球对比传统化疗栓塞治疗分支门脉癌栓肝癌的临床研究

Drug-eluting beads versus conventional chemoembolization for liver cancer with branch portal vein tumor thrombus:a clinical study

目的对比不同经导管动脉内化疗栓塞(TACE)方式应用于分支门脉癌栓(PVTT)肝细胞癌(HCC)患者的疗效及安全性。方法回顾性纳入自2019年12月至2022年8月符合纳排标准的122例有分支PVTT的HCC患者,根据不同的TACE方式分为载药微球组(DEB-TACE)和传统TACE组(cTACE)。通过比较两组患者术后并发症、疼痛来评估两者的安全性。比较两组患者术后1个月的肿瘤反应率、术后的无进展生存时间(PFS)和总体生存时间(OS),探究哪一种TACE方式对有分支PVTT的HCC患者疗效更优。结果两组的术后疼痛分级和并发症发生率基本无差异。TACE后1个月,DEB-TACE组的ORR(P=0.033)及DCR(P=0.096)优于cTACE组。DEB-TACE组和c TACE组的中位PFS分别为10.5个月及6.4个月(P=0.003),中位OS为19.3个月及16.8个月(P=0.019)。结论TACE应用于分支PVTT的HCC患者是有效、安全的,DEB-TACE的术后疗效优于c TACE。为提高这部分患者的预后,我们更应该推荐DEBTACE作为初次介入治疗的方式。

Objective To compare the clinical efficacy and safety of different transcatheter arterial chemoembolization(TACE)schemes in treating hepatocellular carcinoma(HCC)patients with branch portal vein tumor thrombus(PVTT).Methods A total of 122 HCC patients complicated by PVTT,who met the inclusion and exclusion criteria,were enrolled in this retrospective study.According to the TACE scheme used,the patients were divided into drug-eluting beads TACE(DEB-TACE)group and conventional TACE(cTACE)group.The postoperative complications and pain score were used to evaluate the safety of both schemes.The postoperative one-month tumor response rate,the progression-free survival(PFS)and the overall survival(OS)were compared between the two groups,and the results were used to clarify which TACE scheme had a better efficacy for HCC patients complicated by branch PVTT.Results There were no obvious differences in the postoperative pain grade and the incidence of complications between the two groups.One month after TACE,in DEB-TACE group the objective response rate(ORR,P=0.033)and disease control rate(DCR,P=0.096)were better than those in c TACE group.The median PFS in DEB-TACE group and cTACE group was 10.5 months and 6.4 months respectively(P=0.003),and the median OS in DEB-TACE group and cTACE group was 19.3 months and 16.8 months respectively(P=0.019).Conclusion For the treatment of HCC patients complicated by branch PVTT,TACE is clinically effective and safe.DEB-TACE is superior to c TACE in the postoperative efficacy.In order to improve the prognosis of such patients,DEB-TACE should be strongly recommended as an initial interventional treatment scheme.