Hepatol Int: 前瞻性研究评估TACE单纯使用碘油对比TACE使用碘油联合可降解的淀粉微球(DSM)治疗肝细胞癌的疗效

2021-06-28 yd2015 MedSci原创

肝细胞癌(HCC)中经动脉的化疗栓塞(TACE)是常用的治疗手段。近期,Hepatology International杂志发表一项前瞻性研究,评估TACE单纯使用碘油对比碘油联合可降解的淀粉微球(D

肝细胞癌(HCC)中经动脉的化疗栓塞(TACE)是常用的治疗手段。近期,Hepatology International杂志发表一项前瞻性研究,评估TACE单纯使用碘油对比碘油联合可降解的淀粉微球(DSM)在BCLC- B期HCC患者中的疗效。

62例患者符合纳入标准,但最终纳入61例患者,随机化分配治疗TACE单纯使用碘油组(组1)和TACE使用碘油联合DSM组(组2),分别有30和31例患者。

                 研究概况

总体人群中,平均的肿瘤体积减少21.45%(±62.34%)。组1患者的平均肿瘤体积减少为19.95%,组2为22.95% (p = 0.653)。平均直径缩小率为6.26%(±34.75%),其中组1为11.86%组2为4.06% (p = 0.678)。

对于mRECIST标准评估,组2患者较组1患者明显获益(p = 0.010)。其中组1对比组2,完全缓解的患者为0例对比3例,部分缓解的为2例对比7例,病情稳定的为21例对比17例,病情进展的为3例对比1例。仅使用碘油的TACE组坏死直径减少了0.88 cm±6.83 cm(−4.47%±42.77%),而使用DSM的TACE组坏死直径增加了1.10 cm±6.15 cm(+ 4.27%±38.65%),但差异无统计学意义。

           疗效评估

在50例患者中,未见治疗相关并发症。9例患者出现1级并发症,为介入后恶心或发热(14.8%),其中组1有6例(20.0%),组2有5例(16.1%)。2例(3.3%)患者出现过敏反应(2级并发症),每组各1例(3.3%;3.2%)。未见与介入相关的3级或更高的并发症。两组未发现有显著统计学差异的并发症 (p = 0.103)。

整个队列的中位OS为24.61个月(范围为1 54个月)。TACE单用碘油组的中位OS为26.32个月 (范围1 54个月),短于TACE使用碘油联合DSM组的22.77个月(范围2 49个月),但是差异无统计学意义(p = 0.844)。

研究队列的生存分析时,研究队列的中位OS为32.5个月(95%CI: 26.6–38.4),组1的中位OS为29.4个月(95% CI 21.7–37.1),而组2的为33.4个月(95% CI 25.5–41.4)。

            生存分析

Cox回归分析表明,基线低AFP值(p = 0.002),小的肿瘤体积和直径(p = 0.046和p = 0.005)跟较好的生存有关。

综上,对于BCLC- B期HCC患者,在传统的TACE-碘油基础上加用可降解的淀粉微球(DSM)可提高肿瘤应答(根据mRECIST标准),但是预后并没有获益。

原始出处:

T J Vogl, M C Langenbach , R Hammerstingl, et al. Evaluation of two different transarterial chemoembolization protocols using Lipiodol and degradable starch microspheres in therapy of hepatocellular carcinoma: a prospective trial. Hepatol Int. 2021 May 27.  doi: 10.1007/s12072-021-10193-8.

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    2022-05-07 xjy02
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    2021-11-03 shanyongle
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    2021-08-29 grace5700
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    2021-06-30 gwc384
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    2021-06-29 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

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在多变量分析中iCCA和HCC患者的OS相似,但对于有较差预后风险因素的患者,iCCA的OS长于HCC

Lancet oncol:Sintilimab联合贝伐单抗生物仿制药治疗不能切除的肝癌的预后明显优于索拉非尼!

信迪利单抗联合IBI305作为一线治疗方案用于不可手术切除的HBV相关肝癌患者,可提供优于索拉非尼治疗的总生存期和无进展生存期

Brit J Cancer:中性粒细胞与淋巴细胞比值对肝细胞癌患者预后和诊断的意义

中性粒细胞-淋巴细胞比率(NLR)是衡量中性粒细胞相关的肿瘤前炎症和淋巴细胞依赖的抗肿瘤免疫功能之间平衡的一种假定指标,NLR是影响HCC患者生存的一个重要的独立因素。

Br J Cancer:中性粒细胞淋巴细胞比值NLR在肝细胞癌中的预后和诊断意义

肝细胞癌(HCC)的主要预后临床特征包括肿瘤大小和数量、血管浸润的出现、血清甲胎蛋白(AFP)水平、体能状态以及中性粒细胞淋巴细胞比值(NLR)等。