超米兰标准肝细胞癌伴微血管侵犯患者肝移植前DEB-TACE疗效评估及预后分析  

Efficacy and prognosis of DEB-TACE as neoadjuvant therapy before liver transplantation in patients with hepatocellular carcinoma beyond Milan criteria with microvascular invasion

作　　者：叶兆丹 曹国洪 宋梦晨 张景峰 YE Zhaodan;CAO Guohong;SONG Mengchen;ZHANG Jingfeng(Zhejiang Chinese Medical University,Zhejiang 310053,China;Department of Radiology,Shulan(Hang Zhou)Hospital,Zhejiang 310022,China)

机构地区：[1]浙江中医药大学,浙江杭州310053 [2]浙江树人学院树兰国际医学院附属树兰(杭州)医院放射科,浙江杭州310022 [3]宁波市第二医院放射科,浙江宁波315010

出　　处：《影像诊断与介入放射学》2024年第4期271-277,共7页Diagnostic Imaging & Interventional Radiology

基　　金：浙江省自然科学基金基础公益研究计划(LGF19H180004);浙江省医药卫生科技项目(2020KY787)。

摘　　要：目的载药微球经导管肝动脉灌注化疗栓塞术(DEB-TACE)作为超米兰标准肝细胞癌(HCC)合并微血管侵犯(MVI)患者肝移植术前的新辅助治疗,探讨其安全性、疗效及对肝移植预后的影响。方法回顾性分析2016年5月—2022年12月树兰(杭州)医院141例超米兰标准HCC行肝移植患者资料,其中55例患者合并MVI纳入本研究,根据术前是否行DEB-TACE治疗分为DEB-TACE组(n=26)和对照组(n=29),对照组肝移植术前未行任何治疗。采用Kaplan-Meier法评估患者的肝移植术后总生存(OS)率和无复发生存(RFS)率,并用Log-rank检验。结果DEB-TACE术后客观缓解率(ORR)高达88%,术后不良反应以栓塞综合征为主。1、2、3年RFS率DEB-TACE组(88.5%、79.2%、73.9%)高于对照组(69%、50%、44.4%),两组间3年RFS率差异有统计学意义(χ^(2)=4.428,P=0.035)。1、2、3年OS率差异虽然无统计学意义(χ^(2)=3.224,P=0.073),但DEB-TACE组(100%、91.7%、82.6%)仍优于对照组(96.6%、82.1%、59.3%)。结论DEB-TACE可改善超米兰标准HCC合并MVI患者肝移植的预后。Objective To investigate the efficacy and safety of drug-eluting bead transarterial chemoembolization(DEB-TACE)as neoadjuvant therapy before liver transplantation(LT)in patients with hepatocellular carcinoma(HCC)beyond Milan criteria with microvascular invasion(MVI)and its impact on the prognosis after LT.Methods From May 2016 to December 2022,141 patients with HCC beyond Milan criteria underwent LT.A total of 55 patients with MVI were enrolled in the study and were divided into DEB-TACE before LT group(n=26)and control group(n=29)that did not receive any treatment before LT.The Kaplan-Meier method was utilized to estimate the overall survival(OS)rate and recurrence-free survival(RFS)rate after LT after potential prognostic factors for RFS and OS were identified.Results The objective response rate after DEB-TACE was 88%,and the main adverse event was embolization syndrome.The 1-,2-and 3-year RFS rates in DEB-TACE group(88.5%,79.2%and 73.9%)were higher than control group(69%,50%and 44.4%).The 3-year RFS rate was significantly different between the two groups(χ^(2)=4.428,P=0.035).The 1-,2-and 3-year OS rates in DEB-TACE group(100%,91.7%and 82.6%)were not significantly(χ^(2)=3.224,P=0.073)higher than control group(96.6%,82.1%and 59.3%).Conclusion Preoperative DEB-TACE neoadjuvant therapy can improve the prognosis of LT in patients with HCC beyond Milan criteria with MVI.

关 键 词：肝细胞癌 肝移植 微血管侵犯 载药微球经导管肝动脉灌注化疗栓塞 

分 类 号：R735.7[医药卫生—肿瘤] R815[医药卫生—临床医学]