TACE同步微波消融与TACE治疗不同病理分级神经内分泌肿瘤肝转移的临床疗效比较  

Comparison of thermal ablation combined with synchronous TACE and TACE in liver metastasis of neuroendocrine tumors of different pathologic grades

作　　者：YAV Sothea 孙慧怡 王飞航 赵丹阳 霍梓昊 陈颐 颜志平 刘凌晓 YAV Sothea;SUN Hui-yi;WANG Fei-hang;ZHAO Dan-yang;HUO Zi-hao;CHEN Yi;YAN Zhi-ping;LIU Ling-xiao(Department of Interventional Radiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Shanghai Institute of Medical Imaging,Shanghai 200032,China;National Clinical Research Center for Interventional Medicine,Shanghai 200032,China;Department of Radiology,Preah Ketmealea Hospital,Phnom Penh 855,Cambodia)

机构地区：[1]复旦大学附属中山医院介入治疗科,上海200032 [2]上海市影像医学研究所,上海200032 [3]国家放射与治疗临床医学研究中心,上海200032 [4]柬埔寨王家军总医院放射科,金边855

出　　处：《复旦学报（医学版）》2024年第3期323-330,337,共9页Fudan University Journal of Medical Sciences

基　　金：国家卫健委能力建设和继续教育中心项目(GWJJ2022100303);复旦大学医工结合项目(yg2022-6)。

摘　　要：目的对比分析经导管动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)同步联合微波消融与单纯TACE在不同病理分级的神经内分泌肿瘤肝转移患者中的疗效及安全性。方法回顾性分析2006年11月1日至2022年7月31日复旦大学附属中山医院介入治疗科收治的神经内分泌肿瘤肝转移患者,根据治疗方式分为同步消融组和TACE组,并根据病理分级分成相应的亚组,通过术后影像学检查评估病灶,随访至2023年7月31日,记录手术相关并发症,随访终点为患者的无进展生存期(progression-free survival,PFS)及总生存期(overall survival,OS)。结果共纳入86例神经内分泌肿瘤患者,同步消融组34例,TACE组52例。根据2019年WHO消化系统神经内分泌肿瘤的分类和分级标准,将患者分为G1期(21例)、G2期(45例)、G3期(20例)。所有患者均未出现严重的术后并发症。TACE组和同步消融组中位OS分别为47.0(95%CI:31.2~62.8)个月和56.0(95%CI:38.3~73.4)个月,差异无统计学意义(P=0.50);中位PFS分别为18.0(95%CI:6.0~30.0)个月和29.0(95%CI:10.0~48.0)个月,差异无统计学意义(P=0.22)。45例G2期患者中27例接受TACE,中位OS为47.0个月,18例接受同步消融,中位OS是59.0个月,两组差异无统计学意义(P=0.45)。TACE组和同步消融组中位PFS分别为12.0个月和32.0个月,差异有统计学意义(P=0.03)。结论与单独TACE治疗相比,TACE同步微波消融可以延缓神经内分泌肿瘤肝转移患者的病情进展,具有较好的安全性,且更适用于中、低级别的神经内分泌肿瘤肝转移患者。Objective To compare the efficacy and safety between thermal ablation combined with synchronous transcatheter arterial chemoembolization(TACE)and TACE in patients with liver metastasis of neuroendocrine tumors of different pathologic grades.Methods A retrospective analysis was performed on patients with liver metastases of neuroendocrine tumors admitted to Department of Interventional Radiology,Zhongshan Hospital,Fudan University from Nov 1,2006 to Jul 31,2022.The patients were divided into synchronous ablation group and TACE group according to treatment mode and subgroups according to pathological grade.The lesions were evaluated by postoperative imaging examination.The patients were followed up until Jul 31,2023,and surgery-related complications were recorded.The endpoint of prognosis were progression-free survival(PFS)and overall survival(OS).Results A total of 86 patients with neuroendocrine tumor were collected,including 34 patients in simultaneous ablation group and 52 patients in TACE group.According to WHO classification,21 patients at G1 stage,45 patients at G2 stage and 20 patients at G3 stage were included.No serious postoperative complications occurred in all patients.The median OS was 47.0(95%CI:31.2-62.8)months in the TACE group and 56.0(95%CI:8.3-73.4)months in the synchronous ablation group,with no statistical difference between the two groups(P=0.50).The median PFS was 18.0(95%CI:6.0-30.0)months in the TACE group and 29.0(95%CI:10.0-48.0)months in the synchronous ablation group,with no statistical difference between the two groups(P=0.22).Of the 45 patients at G2 stage,27 received TACE with a median OS of 47.0 months,and 18 received synchronous ablation with a median OS of 59.0 months,and there was no statistical difference between the two groups(P=0.45).The median PFS was 12.0 months in the TACE group and 32.0 months in the synchronous ablation group,and the difference between the two groups was statistically significant(P=0.03).Conclusion Comparing with TACE,simultaneous ablation can delay dise

关 键 词：经导管动脉化疗栓塞(TACE) 微波消融 肝动脉化疗栓塞 神经内分泌肿瘤 肝转移 对比分析 

分 类 号：R735.7[医药卫生—肿瘤]