载药微球经导管动脉化疗栓塞术联合肠系膜上动脉灌注化疗治疗肝细胞癌合并门静脉癌栓的效果分析

黄乾鑫; 神斌; 肖晋昌; 高志康; 吕墩涛; 李艳; 徐浩; 张庆桥

doi:10.12449/JCH241216

载药微球经导管动脉化疗栓塞术联合肠系膜上动脉灌注化疗治疗肝细胞癌合并门静脉癌栓的效果分析

DOI: 10.12449/JCH241216

徐州医科大学附属医院介入放射科，江苏徐州 221006

基金项目:

江苏省医学会介入医学第二期科研专项资金项目 (SYH-3201140-0052)

伦理学声明：本研究方案于2023年4月25日经由徐州医科大学附属医院伦理委员会审批，批号：XYFY2023-KL117-01，患者均签署知情同意书。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：黄乾鑫负责课题设计，资料分析，撰写论文；神斌、肖晋昌、高志康、吕墩涛、李艳、徐浩参与收集数据，修改论文；张庆桥负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
张庆桥， 1427286069@qq.com （ORCID： 0000-0001-6177-7081）

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出版历程
- 收稿日期: 2024-04-14
- 录用日期: 2024-07-08
- 出版日期: 2024-12-25

Efficacy of drug-eluting beads-transarterial chemoembolization combined with infusion chemotherapy via superior mesenteric artery in treatment of hepatocellular carcinoma complicated by portal vein tumor thrombus

Department of Interventional Radiology，The Affiliated Hospital of Xuzhou Medical University，Xuzhou，Jiangsu 221006，China

Research funding:

Jiangsu Medical Association Interventional Medicine Second Phase Research Special Funds Project (SYH-3201140-0052)

More Information

Corresponding author: ZHANG Qingqiao， 1427286069@qq.com （ORCID： 0000-0001-6177-7081）

摘要

摘要: 目的对比分析载药微球经导管动脉化疗栓塞术（D-TACE）联合肠系膜上动脉灌注化疗与单纯D-TACE治疗肝细胞癌合并门静脉癌栓（PVTT）的效果。方法回顾性分析徐州医科大学附属医院2022年1月—2023年12月行介入治疗的肝细胞癌合并PVTT的患者资料，其中采用D-TACE联合肠系膜上动脉灌注化疗的患者15例（观察组）。按1∶1进行倾向性匹配后入选单纯D-TACE治疗的患者15例（对照组）。术后1、2、3个月及以后每3个月行上腹部增强MRI评估肝脏肿瘤及PVTT情况。对比分析两组患者客观缓解率（ORR）、疾病控制率（DCR）。计量资料两组间比较采用成组t检验或Mann-Whitney U检验，术前、术后资料比较采用配对t检验或Wilcoxon检验。计数资料两组间比较采用χ²检验。采用Kaplan-Meier曲线计算累积生存率，并使用Log-rank检验比较两组差异。结果两组患者治疗技术成功率100%，术后均无严重并发症。全部患者随访3～26个月，平均（10.5±6.7）个月。术后3个月，观察组和对照组肝脏肿瘤的ORR（73.3% vs 53.3%）和DCR（93.3% vs 80.0%）差异均无统计学意义（P值均>0.05）；观察组PVTT的ORR（46.7% vs 13.3%）和DCR（100% vs 73.3%）均显著高于对照组（χ²值分别为3.968、4.615，P值分别为0.046、0.032）。观察组和对照组患者累积3、6、12个月无进展生存率分别为93.3%、86.2%、68.9%和80.0%、62.2%、24.9%（P=0.028）；累积3、6、12个月总生存率分别为100%、88.9%、88.9%和93.3%、85.6%、70.0%（P=0.340）。结论与单纯D-TACE相比，D-TACE联合肠系膜上动脉灌注化疗在治疗肝细胞癌合并PVTT方面显示了更好的近期疗效。
- 癌，肝细胞 /
- 门静脉癌栓 /
- 化学栓塞，治疗性
Abstract: Objective To investigate the efficacy of drug-eluting beads-transarterial chemoembolization （D-TACE） combined with infusion chemotherapy via superior mesenteric artery versus D-TACE alone in the treatment of hepatocellular carcinoma （HCC） complicated by portal vein tumor thrombus （PVTT）. Methods A retrospective analysis was performed for the data of patients with HCC and PVTT who underwent interventional treatment in The Affiliated Hospital of Xuzhou Medical University from January 2022 to December 2023， among whom 15 patients received D-TACE combined with infusion chemotherapy via superior mesenteric artery and were enrolled as observation group， and after propensity score matching at a ratio of 1∶1， 15 patients who received D-TACE alone were enrolled as control group. Contrast-enhanced MRI of the upper abdomen was performed at 1， 2， and 3 months after surgery and every 3 months thereafter to evaluate the conditions of liver tumor and PVTT. Objective response rate （ORR） and disease control rate （DCR） were compared between the two groups. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the paired t-test or the Wilcoxon test was used for comparison of preoperative and postoperative data； the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier curve was used to calculate the cumulative survival rate， and the Log-rank test was used for comparison between two groups. Results Both groups had a technical success rate of 100%， with no serious complications after surgery. The patients were followed up for 3-26 months （mean 10.5±6.7 months）. At 3 months after surgery， there were no significant differences between the observation group and the control group in ORR （73.3% vs 53.3%， χ²=1.292， P=0.256） and DCR （93.3% vs 80.0%， χ²=1.154， P=0.283） for liver tumors， and compared with the control group， the observation group had significantly higher ORR and DCR for PVTT （ORR： 46.7% vs 13.3%， χ²=3.968， P=0.046； DCR： 100% vs 73.3%， χ²=4.615， P=0.032）. The 3-， 6-， and 12-month cumulative progression-free survival rates were 93.3%， 86.2%， and 68.9%， respectively， for the observation group and were 80.0%， 62.2%， and 24.9%， respectively， for the control group （P=0.028）， and the 3-， 6-， and 12-month cumulative overall survival rates were 100%， 88.9%， and 88.9%， respectively， for the observation group and were 93.3%， 85.6%， and 70.0%， respectively， for the control group （P=0.340）. Conclusion Compared with D-TACE alone， D-TACE combined with infusion chemotherapy via the superior mesenteric artery shows better short-term efficacy in the treatment of HCC complicated by PVTT.
- Carcinoma， Hepatocellular /
- Portal Vein Tumor Thrombus /
- Chemoembolization， Therapeutic

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图 1 66岁男性肝癌合并PVTT患者图像

注： a、b，腹部增强MR示肝左右叶交界处巨块型肝癌伴门静脉主干癌栓；c、d，数字减影血管造影下超选择插管至肿瘤供血动脉行D-TACE治疗，复查造影示肿瘤染色消失；e，保留微导管于肠系膜上动脉行持续灌注化疗；f、g，术后1个月复查增强MR示肝脏肿瘤及PVTT均减小；h，术后5个月复查增强CT示肝脏肿瘤完全缓解，PVTT明显减少。

Figure 1. Image of a 66-year-old male patient with hepatocellular carcinoma and portal vein tumor thrombus

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图 2 两组患者Kaplan-Meier曲线结果

Figure 2. Kaplan-Meier curve results for the two patient groups

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表 1 两组患者基线资料情况比较

Table 1. Comparison of baseline characteristics between the two groups of patients

指标	观察组（n=15）	对照组（n=15）	统计值	P值
年龄（岁）	58.5±10.7	57.7±8.9	t=0.315	0.755
性别［例（%）］			χ²=0.370	0.543
男	14（93.3）	13（86.7）
女	1（6.7）	2（13.3）
Child-Pugh评分（分）	6.3±0.9	6.1±1.1	t=0.374	0.711
Child-Pugh分级［例（%）］			χ²=0.144	0.705
A	9（60.0）	10（66.7）
B	6（40.0）	5（33.3）
肿瘤最大径（mm）	101.5±44.9	95.8±35.6	t=0.323	0.750
肿瘤数量［例（%）］			χ²=0.536	0.464
单个	7（46.7）	9（60.0）
多个	8（53.3）	6（40.0）
PVTT分型［（%）］			χ²=0.311	0.958
Ⅰ型	2（13.3）	3（20.0）
Ⅱ型	7（46.7）	7（46.7）
Ⅲ型	5（33.3）	4（26.7）
Ⅳ型	1（6.7）	1（6.7）
AFP［例（%）］			χ²=1.222	0.269
<400 ng/mL	7（46.7）	10（66.7）
≥400 ng/mL	8（53.3）	5（33.3）

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表 2 两组患者术后1个月肝功能指标变化情况

Table 2. Changes in liver function indicators one month after treatment in the two groups of patients

指标	观察组（n=15）	对照组（n=15）	统计值	P值
AST（U/L）
术前	66.5（45.8～202.8）	61.0（33.0～117.0）	Z=-0.952	0.341
术后1个月	86.0（34.0～119.0）	54.0（33.8～89.0）	Z=-0.986	0.324
ALT（U/L）
术前	44.5（35.0～73.8）	42.0（22.5～80.0）	Z=-0.762	0.446
术后1个月	43.5（23.3～60.3）	28.5（15.8～53.8）	Z=-1.059	0.290
白蛋白（g/L）
术前	35.4±3.4	37.6±4.1	t=1.462	0.157
术后1个月	35.1±5.5	36.2±7.1	t=0.388	0.702
总胆红素（μmol/L）
术前	17.6（12.7～25.2）	14.5（11.6～23.0）	Z=-0.653	0.514
术后1个月	22.5（9.9～26.7）	24.9（14.9～54.5）	Z=-1.021	0.307

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表 3 两组患者术后3个月疗效评价

Table 3. Assessment of efficacy at three months postoperatively in the two groups of patients

组别	例数	肝脏肿瘤［例（%）］	PVTT［例（%）］
观察组	15
CR		1（6.7）	0（0.0）
PR		10（66.7）	7（46.7）
SD		3（20.0）	8（53.3）
PD		1（6.7）	0（0.0）
对照组	15
CR		1（6.7）	0（0.0）
PR		7（46.7）	2（13.3）
SD		4（26.7）	9（60.0）
PD		3（20.0）	4（26.7）

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