肝动脉栓塞术治疗42例低-中级别乏血供型神经内分泌肿瘤肝转移的近期疗效及安全性分析

doi:10.3877/cma.j.issn.2095-5782.2020.02.006

中华介入放射学电子杂志 ›› 2020, Vol. 08 ›› Issue (02) : 130 -134. doi: 10.3877/cma.j.issn.2095-5782.2020.02.006

所属专题：经典病例；经典病例；文献；

肿瘤介入

肝动脉栓塞术治疗42例低-中级别乏血供型神经内分泌肿瘤肝转移的近期疗效及安全性分析

刘海宽¹, 陈文川¹, 刘一铭², 姚望¹, 范文哲¹, 李家平¹, 陈洁³, 王于¹^,^†(

)

^1. 510080　广东广州，中山大学附属第一医院肿瘤介入科
^2. 510655　广东广州，中山大学附属第六医院超声科
^3. 510080　广东广州，中山大学附属第一医院消化内科

收稿日期:2020-02-10 出版日期:2020-05-25
通信作者: 王于
基金资助:
广东省自然科学基金(2016A030313206); 广东省重大科技专项(2017B030308006); 广州市重大科技攻关计划项目(201704020144); 国家自然科学基金项目(81171441、81971719)

Transarterial embolization in the treatment of 42 patients with low-to-intermediate grade neuroendocrine neoplasm liver metastasis with hypovascular pattern: an analysis of the short-term efficacy and safety

Haikuan Liu¹, Wenchuan Chen¹, Yiming Liu², Wang Yao¹, Wenzhe Fan¹, Jiaping Li¹, Jie Chen³, Yu Wang¹^,^†()

^1. Department of Interventional Oncology, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Guangzhou 510080, China
^2. Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Guangzhou 510655, China
^3. Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen University, Guangdong Guangzhou 510080, China

Received:2020-02-10 Published:2020-05-25
Corresponding author: Yu Wang
About author:
Corresponding author: Wang Yu, Email: zsyyjr@163.com

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引用本文：

刘海宽, 陈文川, 刘一铭, 姚望, 范文哲, 李家平, 陈洁, 王于. 肝动脉栓塞术治疗42例低-中级别乏血供型神经内分泌肿瘤肝转移的近期疗效及安全性分析[J]. 中华介入放射学电子杂志, 2020, 08(02): 130-134.

Haikuan Liu, Wenchuan Chen, Yiming Liu, Wang Yao, Wenzhe Fan, Jiaping Li, Jie Chen, Yu Wang. Transarterial embolization in the treatment of 42 patients with low-to-intermediate grade neuroendocrine neoplasm liver metastasis with hypovascular pattern: an analysis of the short-term efficacy and safety[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2020, 08(02): 130-134.

目的

总结分析低-中级别乏血供型神经内分泌肿瘤肝转移（NENLM）经肝动脉栓塞术（TAE）治疗后的近期疗效及安全性。

方法

从2016年1月至2019年12月在我院经TAE治疗的不同原发部位的低-中级别NENLM患者中，选取其中术前影像学表现为乏血供型、且术后经影像学复查的42例，分别按照RECIST 1.1和mRECIST标准来评价疗效，分别分析其术后1～3个月客观缓解率（ORR）及疾病控制率（DCR）。术后不良反应分级采用CTCAE （v5.0）标准。

结果

TAE治疗对于低-中级别乏血供型NENLM具有显著的减瘤作用，按照RECIST 1.1来评价，ORR为66.7%，DCR为92.9%，按照mRECIST标准来评价，ORR为85.7%，DCR为92.9%，其中CR率为16.7%。不良反应主要为发热（88.1%）、肝区疼痛（78.6%）及肝功能一过性损伤（肝酶升高：40.5%；胆红素升高：19.1%）等，对症处理后均可缓解，无严重术后并发症。

结论

部分低-中级别NENLM尽管在术前影像学上主要表现为乏血供特征，但是经TAE治疗后ORR显著，TAE是一种安全且有效的减瘤手段。

关键词: 肝动脉栓塞术, 神经内分泌肿瘤, 肝转移瘤, 乏血供, 疗效与安全

Objective

To summarize and analyse the short-term efficacy and safety of transarterial embolization (TAE) on low-to-intermediate grade neuroendocrine neoplasm liver metastasis (NENLM) with hypovascular pattern.

Methods

From January 2016 to December 2019, at the First Affiliated Hospital of Sun Yat-sen University, among the patients with different primary site of low-to-intermediate grade NENLM after the treatment of TAE, 42 cases were selected whose preoperative imaging findings for lack of blood supply. All cases had completed postoperative imaging evaluation. Respectively according to RECIST 1.1 and mRECIST criteria to evaluate the curative effect, the objective response rate (ORR) and disease control rates (DCR) were calculated within 1-3 months after the operation. Recorded the postoperative adverse events according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0.

Results

TAE has a significant debulking effect on low-to-intermediate grade NENLM with hypovascular pattern, which was evaluated according to RECIST 1.1, ORR was 66.7%, DCR was 92.9%. And according to mRECIST criteria, ORR was 85.7%, DCR was 92.9%, and CR rate was 16.7%. The major complications were fever (88.1%), hepatic pain (78.6%) and transient liver dysfunction [elevated liver enzymes (40.5%), elevated bilirubin (19.1%)], which can be alleviated after symptomatic treatment. There is no serious postoperative complications.

Conclusions

Although some low-to-intermediate grade NENLM is characterized by lack of blood supply in imaging, its ORR is still significant after TAE. TAE is safe and effective in reducing burden in NENLM with hypovascular pattern.

Key words: Transarterial embolization, Neuroendocrine neoplasm, Liver metastasis, Hypovascular, Efficacy and safety

表1 42例NENLM患者临床资料

临床资料	分组	病例数
年龄	≥60岁	17
年龄	<60岁	25
性别	男	26
性别	女	16
原发部位	直肠	33
	小肠	4
	胰腺	2
	胃	2
	肺	1
Ki-67	1～2	7
Ki-67	3～20	35
级别	G1	7
级别	G2	35
局部治疗史	无	40
局部治疗史	切除	2
全身用药	SSA	37
全身用药	依维莫司	5

表1 42例NENLM患者临床资料

临床资料	分组	病例数
年龄	≥60岁	17
年龄	<60岁	25
性别	男	26
性别	女	16
原发部位	直肠	33
	小肠	4
	胰腺	2
	胃	2
	肺	1
Ki-67	1～2	7
Ki-67	3～20	35
级别	G1	7
级别	G2	35
局部治疗史	无	40
局部治疗史	切除	2
全身用药	SSA	37
全身用药	依维莫司	5

图1 直肠NENLM（TxN0M1 IV期，G2级），45岁，男性患者

表2 治疗效果

?	RECIST 1.1 %（n）	mRECIST %（n）
CR	0(0)	16.7(7)
PR	66.7(28)	69.0(29)
SD	26.2(11)	7.1(3)
PD	7.1(3)	7.1(3)
ORR	66.7(28)	85.7(36)
DCR	92.9(39)	92.9(39)

表2 治疗效果

?	RECIST 1.1 %（n）	mRECIST %（n）
CR	0(0)	16.7(7)
PR	66.7(28)	69.0(29)
SD	26.2(11)	7.1(3)
PD	7.1(3)	7.1(3)
ORR	66.7(28)	85.7(36)
DCR	92.9(39)	92.9(39)

表3 术后不良反应

不良反应	Ⅰ级%（n）	Ⅱ级%（n）	Ⅲ级%（n）
血压升高	23.8(10)	0(0)	0(0)
乏力	52.4(22)	2.4(1)	0(0)
发热	85.7(36)	2.4(1)	0(0)
肝区疼痛	64.3(27)	14.3(6)	0(0)
恶心呕吐	28.6(12)	0(0)	0(0)
肝酶升高	40.5(17)	0(0)	0(0)
胆红素升高	19.1(8)	0(0)	0(0)
肝脓肿	0(0)	2.4(1)	0(0)

表3 术后不良反应

不良反应	Ⅰ级%（n）	Ⅱ级%（n）	Ⅲ级%（n）
血压升高	23.8(10)	0(0)	0(0)
乏力	52.4(22)	2.4(1)	0(0)
发热	85.7(36)	2.4(1)	0(0)
肝区疼痛	64.3(27)	14.3(6)	0(0)
恶心呕吐	28.6(12)	0(0)	0(0)
肝酶升高	40.5(17)	0(0)	0(0)
胆红素升高	19.1(8)	0(0)	0(0)
肝脓肿	0(0)	2.4(1)	0(0)

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Transarterial embolization in the treatment of 42 patients with low-to-intermediate grade neuroendocrine neoplasm liver metastasis with hypovascular pattern: an analysis of the short-term efficacy and safety