经皮热消融同步经动脉化疗栓塞(TACE)治疗进展期肝内胆管癌(ICC)的临床疗效及预后因素分析
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摘要
目的回顾性分析经皮热消融同步经动脉化疗栓塞(transarterial chemoembolization,TACE)治疗进展期肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)的安全性和有效性,并分析预后因素。方法纳入2010年6月至2017年3月于复旦大学附属中山医院接受经皮热消融同步TACE治疗的进展期ICC患者53例。随访并收集患者的临床资料,根据mRECIST标准评估治疗效果,统计并分析患者手术相关并发症、总生存期(overall survival,OS)、无进展生存期(progression-free survival,PFS)及预后影响因素。结果 53例患者共行83次经皮热消融同步TACE治疗,有效率(response rate,RR)为80.7%,中位PFS和中位OS分别为7.2和20.9个月。1、2、3年累积生存率分别为72.6%、39.1%和24.3%。6、12及18个月累积无进展生存率分别为58.3%、40.4%和24.2%。多因素分析显示Child-Pugh分级是经皮热消融同步TACE治疗进展期ICC患者生存预后的主要风险因素。1例患者术中出现迷走神经反射,2例患者术后出现肝脓肿,未观察到手术相关死亡病例。结论本研究表明经皮热消融同步TACE治疗进展期ICC是安全有效的。
Objective To retrospectively evaluate the safety and efficacy of percutaneous thermal ablation combined with simultaneous transarterial chemoembolization(TACE) for advanced intrahepatic cholangiocarcinoma(ICC). Methods From Jun.,2010 to Mar.,2017,a total of 53 patients with advanced ICC who underwent percutaneous thermal ablation combined with simultaneous TACE in Zhongshan Hospital,Fudan University were enrolled in this study.Their clinical data were collected and reviewed.The tumor response was assessed according to mRECIST criteria.The treatment-related complications,overall survival(OS),progression-free survival(PFS) and prognostic factors were analyzed by SPSS 24. Results The response rate(RR) was 80.7% and the median PFS and the median OS were 7.2 and 20.9 months,respectively.The cumulative survival rates at 1,2,and 3 years were 72.6%,39.1% and 24.3%.The cumulative progression-free survival rates at 6,12,and 18 months were 58.3%,40.4% and 24.2%.Child-Pugh classification was a prognostic factor in patients with advanced ICC who were treated with percutaneous thermal ablation combined with simultaneous TACE.The vagal reflex during procedure occurred in 1 patient,and liver abscesses after treatment happened in 2 patients,while no treatment-related deaths were observed. Conclusions This study demonstrates that percutaneous thermal ablation combined with simultaneous TACE is safe and effective for advanced ICC.
Objective To retrospectively evaluate the safety and efficacy of percutaneous thermal ablation combined with simultaneous transarterial chemoembolization(TACE) for advanced intrahepatic cholangiocarcinoma(ICC). Methods From Jun.,2010 to Mar.,2017,a total of 53 patients with advanced ICC who underwent percutaneous thermal ablation combined with simultaneous TACE in Zhongshan Hospital,Fudan University were enrolled in this study.Their clinical data were collected and reviewed.The tumor response was assessed according to mRECIST criteria.The treatment-related complications,overall survival(OS),progression-free survival(PFS) and prognostic factors were analyzed by SPSS 24. Results The response rate(RR) was 80.7% and the median PFS and the median OS were 7.2 and 20.9 months,respectively.The cumulative survival rates at 1,2,and 3 years were 72.6%,39.1% and 24.3%.The cumulative progression-free survival rates at 6,12,and 18 months were 58.3%,40.4% and 24.2%.Child-Pugh classification was a prognostic factor in patients with advanced ICC who were treated with percutaneous thermal ablation combined with simultaneous TACE.The vagal reflex during procedure occurred in 1 patient,and liver abscesses after treatment happened in 2 patients,while no treatment-related deaths were observed. Conclusions This study demonstrates that percutaneous thermal ablation combined with simultaneous TACE is safe and effective for advanced ICC.
引文
[1] 沈锋,张汉,杨田,等.肝内胆管癌的外科综合治疗[J].中华消化外科杂志,2018,17(3):213-218.
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[14] 孙健,吴志全.肝内胆管细胞癌的诊断和治疗[J].中华肝胆外科杂志,2008,14(12):907-909.
[15] ZHU AX,ABOU-ALFA GK.Expanding the treatment options for hepatocellular carcinoma:combining transarterial chemoembolization with radiofrequency ablation[J].JAMA,2008,299(14):1716-1718.
[16] ZHANG S,HU P,WANG N,et al.Thermal ablation versus repeated hepatic resection for recurrent intrahepatic cholangiocarcinoma[J].Ann Surg Oncol,2013,20(11):3596-3602.
[17] NAKANO M,ARIIZUMI SI,YAMAMOTO M.Intrahepatic cholangiocarcinoma[J].Semin Diagn Pathol,2017,34(2):160-166.
[18] CARRAFIELLO G,LAGANà D,COTTA E,et al.Radiofrequency ablation of intrahepatic cholangiocarcinoma:preliminary experience[J].Cardiovasc Inter Rad,2010,33(4):835-839.
[19] NI JY,LIU SS,XU LF,et al.Transarterial chemoembolization combined with percutaneous radiofrequency ablation versus TACE and PRFA monotherapy in the treatment for hepatocellular carcinoma:a meta-analysis[J].J Cancer Res Clin Oncol,2013,139(4):653-659.
[20] YU M,LIANG P,YU X,et al.Sonography-guided percutaneous microwave ablation of intrahepatic primary cholangiocarcinoma[J].Eur J Radiol,2011,80(2):548-552.
[21] KUHLMANN JB,EURINGER W,SPANGENBERG HC,et al.Treatment of unresectable cholangiocarcinoma:conventional transarterial chemoembolization compared with drug eluting bead-transarterial chemoembolization and systemic chemotherapy[J].Eur J Gastroenterol Hepatol,2012,24(4):437-443.
[22] FU Y,YANG W,WU W,et al.Radiofrequency ablation in the management of unresectable intrahepatic cholangiocarcinoma[J].J Vasc Interv Radiol,2012,23(5):642-649.
[23] YANG GW,ZHAO Q,QIAN S,et al.Percutaneous microwave ablation combined with simultaneous transarterial chemoembolization for the treatment of advanced intrahepatic cholangiocarcinoma[J].Onco Targets Ther,2015,8:1245-1250.
[24] LENCIONI R.Loco-regional treatment of hepatocellular carcinoma[J].Hepatology,2010,52(2):762-773.
[25] 刘凌晓,王建华,王小林,等.经皮热消融同步肝动脉化疗栓塞(TACE)治疗肝癌的临床价值[J].复旦学报(医学版),2015,42(1):1-6.
[2] PUHALLA H,SCHUELL B,POKORNY H,et al.Treatment and outcome of intrahepatic cholangiocellular carcinoma[J].Am J Surg,2005,189(2):173-177.
[3] ZHANG K,YU J,YU X,et al.Clinical and survival outcomes of percutaneous microwave ablation for intrahepatic cholangiocarcinoma[J].Int J Hyperthermia,2018,34(3):292-297.
[4] MAVROS MN,ECONOMOPOULOS KP,ALEXIOU VG,et al.Treatment and prognosis for patients with intrahepatic cholangiocarcinoma[J].JAMA Surg,2014,149(6):565.
[5] ABDELAZIZ AO,ABDELMAKSOUD AH,NABEEL MM,et al.Transarterial chemoembolization combined with either radiofrequency or microwave ablation in management of hepatocellular carcinoma[J].Asian Pac J Cancer Prev,2017,18(1):189-194.
[6] POTRETZKE TA,ZIEMLEWICZ TJ,HINSHAW JL,et al.Microwave versus radiofrequency ablation treatment for hepatocellular carcinoma:a comparison of efficacy at a single center[J].J Vasc Interv Radiol,2016,27(5):631-638.
[7] LLOVET JM,BRUIX J.Systematic review of randomized trials for unresectable hepatocellularcarcinoma:Chemoembolization improves survival[J].Hepatology,2003,37(2):429-442.
[8] BRIDGEWATER JGPR.Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma[J].J Hepatol,2014,60(6):1268-1289.
[9] CHUN YS,PAWLIK TM,VAUTHEY J.8th Edition of the AJCC cancer staging manual:pancreas and hepatobiliary cancers[J].Ann Surg Oncol,2018,25(4):845-847.
[10] EISENHAUER EA,THERASSE P,BOGAERTS J,et al.New response evaluation criteria in solid tumours:Revised RECIST guideline (version 1.1)[J].Eur J Cancer,2009,45(2):228-247.
[11] BERGQUIST A,VON SETH E.Epidemiology of cholangiocarcinoma[J].Best Pract Res Clin Gastroenterol,2015,29(2):221-232.
[12] DODSON RM,WEISS MJ,COSGROVE D,et al.Intrahepatic cholangiocarcinoma:management options and emerging therapies[J].J Am Coll Surgeons,2013,217(4):736-750.
[13] HAN K,KO HK,KIM KW,et al.Radiofrequency ablation in the treatment of unresectable intrahepatic cholangiocarcinoma:systematic review and Meta-analysis[J].J Vasc Interv Radiol,2015,26(7):943-948.
[14] 孙健,吴志全.肝内胆管细胞癌的诊断和治疗[J].中华肝胆外科杂志,2008,14(12):907-909.
[15] ZHU AX,ABOU-ALFA GK.Expanding the treatment options for hepatocellular carcinoma:combining transarterial chemoembolization with radiofrequency ablation[J].JAMA,2008,299(14):1716-1718.
[16] ZHANG S,HU P,WANG N,et al.Thermal ablation versus repeated hepatic resection for recurrent intrahepatic cholangiocarcinoma[J].Ann Surg Oncol,2013,20(11):3596-3602.
[17] NAKANO M,ARIIZUMI SI,YAMAMOTO M.Intrahepatic cholangiocarcinoma[J].Semin Diagn Pathol,2017,34(2):160-166.
[18] CARRAFIELLO G,LAGANà D,COTTA E,et al.Radiofrequency ablation of intrahepatic cholangiocarcinoma:preliminary experience[J].Cardiovasc Inter Rad,2010,33(4):835-839.
[19] NI JY,LIU SS,XU LF,et al.Transarterial chemoembolization combined with percutaneous radiofrequency ablation versus TACE and PRFA monotherapy in the treatment for hepatocellular carcinoma:a meta-analysis[J].J Cancer Res Clin Oncol,2013,139(4):653-659.
[20] YU M,LIANG P,YU X,et al.Sonography-guided percutaneous microwave ablation of intrahepatic primary cholangiocarcinoma[J].Eur J Radiol,2011,80(2):548-552.
[21] KUHLMANN JB,EURINGER W,SPANGENBERG HC,et al.Treatment of unresectable cholangiocarcinoma:conventional transarterial chemoembolization compared with drug eluting bead-transarterial chemoembolization and systemic chemotherapy[J].Eur J Gastroenterol Hepatol,2012,24(4):437-443.
[22] FU Y,YANG W,WU W,et al.Radiofrequency ablation in the management of unresectable intrahepatic cholangiocarcinoma[J].J Vasc Interv Radiol,2012,23(5):642-649.
[23] YANG GW,ZHAO Q,QIAN S,et al.Percutaneous microwave ablation combined with simultaneous transarterial chemoembolization for the treatment of advanced intrahepatic cholangiocarcinoma[J].Onco Targets Ther,2015,8:1245-1250.
[24] LENCIONI R.Loco-regional treatment of hepatocellular carcinoma[J].Hepatology,2010,52(2):762-773.
[25] 刘凌晓,王建华,王小林,等.经皮热消融同步肝动脉化疗栓塞(TACE)治疗肝癌的临床价值[J].复旦学报(医学版),2015,42(1):1-6.