Cancers:经动脉放射栓塞术(TARE)治疗不可切除肝细胞癌(HCC)安全有效

2022-01-26 yd2015 MedSci原创

研究表明,经动脉放射栓塞术(TARE)治疗不可切除肝细胞癌(HCC)安全有效。

肝细胞癌是世界上最常见的癌症死亡原因之一,经动脉放射栓塞术(TARE)已被广泛应用于治疗肝细胞癌。近期,Cancers杂志上发表了来自韩国的多中心研究,评估接受TARE治疗的肝细胞癌(HCC)患者的长期临床结果。

从2008年到2014年,共纳入149名接受TARE治疗的HCC患者。中位随访时间为16.9个月(范围:1 139个月)。平均年龄60.6 ~ 12.6岁,男性117例(78.5%)。HCC最常见的原因是乙肝病毒感染(58.4%),其次是丙肝病毒感染(28.2%)和酒精(6.7%)。绝大多数(90.6%)患者为未治疗的, 12例(8.1%)患者曾行TACE, 2例(1.3%)患者在TARE前曾行过手术。BCLC C期患者最多(41.6%),其次为B期(34.2%)和A期(24.2%)。58例(38.9%)患者发生门静脉血栓(PVT)。

67例(45.9%)患者观察到客观缓解,而疾病控制率为74.5%。与BCLC A和B期患者相比,BCLC C期患者的客观缓解率和疾病控制率显著降低(两者p <0.001)。

          疗效评估

中位OS和PFS分别为18.6个月(范围:1-139个月)和8.9个月(范围:0.7-139个月)。1、2、3、5年的OS率分别为62.1%、45.2%、36.2%和30.9%,PFS率分别为42.4%、31.2%、22.7%和17.7%。

              OS和PFS

CTP A组患者的中位OS显著优于B组(21.2 vs. 5个月,p<0.001),且无PVT患者明显优于PVT患者(24.4 vs. 7个月,p = 0.003)。BCLC A期的中位生存期为51.3个月,BCLC B期为27.5个月,BCLC C期为6.5个月,反映了肝功能和肿瘤侵袭性的影响。BCLC A期中位治疗至进展时间(TTP)为42.5个月,BCLC B期为12.7个月(p = 0.082), BCLC C期为8.9个月(p = 0.028)。

               OS亚组分析

PFS也观察到了类似的结果,CTP A患者的中位PFS优于CTP B患者(9.3个月vs 3.7个月,p <0.001),无PVT患者比PVT患者好(11.8 vs. 4.9个月,p = 0.002), BCLC A期患者PFS优于BCLC B期患者(25.7 vs. 12个月,p = 0.056),和BCLC C期患者(4.6个月,p<0.001)。

                PFS亚组分析

有反应者(CR和PR)与无反应者相比较,中位OS(41.9个月vs 11.6个月,p<0.001)和PFS(22个月vs. 4.6个月,p<0.001)有显著统计学差异。

             有无应答的OS和PFS差异

60例患者发生并发症(40.3%);其中,TARE后7天内4例发生3级不良事件(AEs)。由于患者可能有多个AE,根据毒性分级共123例,1/2级AE占总AE的91.1%,3级AE占8.9%。最常见的1/2级AEs为胃肠道症状,如腹痛、恶心、厌食、疲劳和腹泻。3级AEs包括恶心、厌食、腹痛改善无后遗症和其他AEs(胆囊炎、败血症、腹腔干剥离和HCC破裂)。

                 不良反应

综上,研究表明,经动脉放射栓塞术(TARE)治疗不可切除肝细胞癌(HCC)安全有效。

 

原始出处:

Yim, S.Y.; Chun, H.S.; Lee, J.S.; Lim, J.-H.; Kim, T.H.; Kim, B.K.; Kim, S.U.; Park, J.Y.; Ahn, S.H.; Kim, G.M.; et al. Transarterial Radioembolization for Unresectable Hepatocellular Carcinoma: Real-Life Efficacy and Safety Analysis of Korean Patients. Cancers 2022, 14, 385. https://doi.org/10.3390/cancers14020385

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    2022-04-24 anminleiryan
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    2022-07-08 xjy02
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    2022-01-27 jiyangfei

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