DEB-TACE在超米兰标准肝细胞癌患者肝移植术前的应用价值  

The value of DEB-TACE in the preoperative application of hepatocellular carcinoma liver transplantation beyond Milan criteria

作　　者：王浩[1,2] 陈光[2] 高海军[2] 伊正甲[2] 蒋文涛 沈文[1,2] Wang Hao;Chen Guang;Gao Haijun;Yi Zhengjia;Jiang Wentao;Shen Wen(First Central Hospital Institute,Tianjin Medical University,Tianjin 300192,China;Department of Radiology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津医科大学一中心临床学院,天津300192 [2]天津市第一中心医院放射科,天津300192

出　　处：《中华肝胆外科杂志》2022年第3期194-197,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨载药微球经导管肝动脉化疗栓塞(DEB-TACE)在超米兰标准肝细胞癌患者肝移植术前的应用价值。方法回顾分析2013年4月至2019年3月于天津市第一中心医院接受肝移植的超米兰标准的100例肝细胞癌患者资料,其中男性72例,女性28例,年龄(50.3±7.8)岁。将术前接受DEB-TACE治疗的50例患者纳入DEB-TACE组,根据肝移植术后的肿瘤坏死率再分为A组(肿瘤完全坏死,n=9)、B组(50%≤肿瘤坏死率<100%,n=21)、C组(肿瘤坏死率<50%,n=20)。将未接受任何术前治疗的50例患者纳入对照组。分析DEB-TACE并发症。门诊复查和电话随访其生存和复发情况。Kaplan-Meier法进行生存分析,生存率比较采用log-rank检验。结果DEB-TACE组患者介入治疗的技术成功率为100.0%(50/50),接受1~4(1.8±1.2)次介入治疗。DEB-TACE术后并发症,发生栓塞后综合征18例(36.0%)。DEB-TACE组肝移植术后1、2、3年累积生存率分别为96.0%、90.0%、76.0%,优于对照组94.0%、78.0%、54.0%,差异有统计学意义(χ^(2)=6.62,P=0.015)。A组+B组患者(n=30)肝移植术后1、2、3年累积生存率分别为100.0%、96.7%、93.3%,优于对照组94.0%、78.0%、54.0%,差异有统计学意义(χ^(2)=6.99,P=0.012)。C组与对照组肝移植术后累积生存率比较,差异无统计学意义(χ^(2)=0.56,P=0.130)。累积无复发生存率组间比较结果与累积生存率比较结果一致。结论超米兰标准肝细胞癌患者肝移植术前行DEB-TACE治疗可以提高生存率,DEB-TACE后肿瘤坏死程度越高(超过50%或完全坏死),其生存预后越好。Objective To investigate the clinical value of drug-eluting beads transcatheter arterial chemoembolization(DEB-TACE)in preoperative liver transplantation application of hepatocellular carcinoma beyond Milan standard.Methods A total of 100 patients with hepatocellular carcinoma who were underwent liver transplantation exceeding Milan criteria were retrospectively analyzed from April 2013 to March 2019 at the Tianjin First Central Hospital.Of 72 males and 28 females were included,aged(50.3±7.8)years.Fifty patients who received preoperative DEB-TACE treatment were included in the DEB-TACE group.According to the tumor necrosis rate after liver transplantation,they were further divided into group A(complete tumor necrosis),group B(50%≤tumor necrosis rate<100%)and group C(tumor necrosis rate<50%).Fifty patients with hepatocellular carcinoma who did not receive any preoperative treatment were included in the control group.DEB-TACE complications were analyzed.Their survival and recurrence were followed up.Survival analysis was performed by Kaplan-Meier method and survival rates were compared by log-rank test.Results In the DEB-TACE group,the technical success rate of interventions was 100%(50/50)and 1 to 4(1.8±1.2)interventions were received.Post-DEB-TACE complications,included post-embolization syndrome in 18 cases(36.0%).Cumulative survival rates at 1,2 and 3 years after liver transplantation in the DEB-TACE group were 96.0%,90.0%,and 76.0%,respectively,which were better than the control group with 94.0%,78.0%,and 54.0%.The differences were statistically significant(χ^(2)=6.62,P=0.015).The cumulative survival rates at 1,2 and 3 years after liver transplantation for patients in group A+B(n=30)were 100.0%,96.7%and 93.3%respectively,which were better than 94.0%,78.0%and 54.0%for the control group,with statistically significant differences(χ^(2)=6.99,P=0.012).The cumulative survival rates after liver transplantation for group C compared with the control group were not statistically significant(χ^(2)=0.56,P=0.130).Th

关 键 词：癌 肝细胞 肝移植 预后 经导管肝动脉化疗栓塞 

分 类 号：R735.7[医药卫生—肿瘤]