TACE治疗胰腺神经内分泌肿瘤肝转移的疗效分析
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摘要
目的评估肝动脉化疗栓塞(TACE)治疗胰腺神经内分泌肿瘤(PNET)肝转移的疗效。方法回顾性收集经手术或穿刺病理证实的25例PNET肝转移行TACE治疗的患者资料,共进行了87次TACE术。经MRI评价其有效率,并分析无进展生存期(PFS)、总生存期(OS)和并发症。结果所有25例患者均顺利完成介入治疗。MRI疗效评估结果为CR 0例,PR 15例,SD 4例,PD 6例,有效率60.0%;中位PFS 13个月,中位OS 18个月;1例术中出现假性动脉瘤,所有病例术后均无严重并发症。结论对于不能手术切除的PNET肝转移患者,行TACE治疗既安全又能获得较好的临床疗效。
Objective To evaluate the curative efficacy of transcatheter arterial chemoembolization(TACE) in the treatment of hepatic metastases from pancreatic neuroendocrine tumors(PNET). Methods The clinical data of 25 patients with surgically or pathologically proved hepatic metastases from PNET, who received TACE, were retrospectively analyzed. A total of 87 TACE procedures were performed. The effective rate was evaluated by MRI, and the progression-free survival time(PFS), overall survival time(OS) and complications were analyzed. Results The interventional therapy was successfully accomplished in all the 25 patients. The MRI evaluation of the curative effect showed that complete remission(CR) was obtained in 0 patient, partial remission(PR) in 15 patients, stable disease(SD) in 4 patients, and progression disease(PD)in 6 patients. The total effective rate was 60%. The median PFS was 13 months and the median OS was 18 months. No serious complications occurred in all patients except for one patient who developed pseudoaneurysm during operation. Conclusion For the treatment of patients with inoperable hepatic metastases from PNET, TACE is safe and effective.
Objective To evaluate the curative efficacy of transcatheter arterial chemoembolization(TACE) in the treatment of hepatic metastases from pancreatic neuroendocrine tumors(PNET). Methods The clinical data of 25 patients with surgically or pathologically proved hepatic metastases from PNET, who received TACE, were retrospectively analyzed. A total of 87 TACE procedures were performed. The effective rate was evaluated by MRI, and the progression-free survival time(PFS), overall survival time(OS) and complications were analyzed. Results The interventional therapy was successfully accomplished in all the 25 patients. The MRI evaluation of the curative effect showed that complete remission(CR) was obtained in 0 patient, partial remission(PR) in 15 patients, stable disease(SD) in 4 patients, and progression disease(PD)in 6 patients. The total effective rate was 60%. The median PFS was 13 months and the median OS was 18 months. No serious complications occurred in all patients except for one patient who developed pseudoaneurysm during operation. Conclusion For the treatment of patients with inoperable hepatic metastases from PNET, TACE is safe and effective.
引文
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[13]隋燕霞,党诚学,张勇,等.原发性胰腺神经内分泌肿瘤60例临床病理分析[J].临床与实验病理学杂志,2015,31:873-876.
[14]Pathak S,Dash I,Taylor MR,et al.The surgical management of neuroendocrine tumour hepatic metastases[J].Eur J Surg Oncol,2013,39:224-228.
[15]Kennedy A,Bester L,Salem R,et al.Role of hepatic intraarterial therapies in metastatic neuroendocrine tumours(NET):guidelines from the NET-Liver-Metastases Consensus Conference[J].HPB(Oxford),2015,17:29-37.
[16]Hur S,Chung JW,Kim HC,et al.Survival outcomes and prognostic factors of transcatheter arterial chemoembolization for hepatic neuroendocrine metastases[J].J Vasc Interv Radiol,2013,24:947-956.
[17]李晓光,金征宇,潘杰,等.肝动脉化疗或栓塞治疗胰腺神经内分泌肿瘤肝转移的疗效分析[J].介入放射学杂志,2010,19:442-446.
[18]房星宇,于淼,杨倚天,等.肝动脉化疗栓塞及射频消融治疗胰腺神经内分泌肿瘤肝转移的疗效和生存分析[J].介入放射学杂志,2013,22:377-380.
[2]楼文晖,吴文铭,赵玉沛,等.胰腺神经内分泌肿瘤治疗指南(2014)[J].临床肝胆病杂志,2014,52:1246-1248.
[3]Frilling A,Modlin IM,Kidd M,et al.Recommendations for management of patients with neuroendocrine liver metastases[J].Lancet Oncol,2014,15:e8-e21.
[4]Minami CA,Bilimoria KY.Databases as vehicles for comparative effectiveness research[J].J Natl Compr Canc Netw,2015,13:1585-1588.
[5]Yuan CH,Wang J,Xiu DR,et al.Meta-analysis of liver resection versus nonsurgical treatments for pancreatic neuroendocrine tumors with liver metastases[J].Ann Surg Oncol,2016,23:244-249.
[6]Anthony LB.Practical guide to supportive care of patients with functional neuroendocrine tumors[J].Semin Oncol,2013,40:45-55.
[7]Kvols LK,Turaga KK,Strosberg J,et al.Role of interventional radiology in the treatment of patients with neuroendocrine metastases in the liver[J].J Natl Compr Canc Netw,2009,7:765-772.
[8]Zhang S,Li YX,Li NS,et al.Octreotide acetate long-acting release in treatment of pancreatic neuroendocrine tumors[J].Chin Med J(Engl),2009,122:1582-1584.
[9]Knigge U,Hansen CP,Stadil F.Interventional treatment of neuroendocrine liver metastases[J].Surgeon,2008,6:232-239.
[10]Pavel M,Baudin E,Couvelard A,et al.ENETS consensus guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut,midgut,hindgut,and unknown primary[J].Neuroendocrinology,2012,95:157-176.
[11]吴勇超,李智岗.肝脏转移瘤血供的影像及病理研究[J].介入放射学杂志,2012,21:520-523.
[12]陈锦秀,任静,王闽,等.MRI动态增强扫描在肝转移瘤诊断及血供分析中的应用(附60例病例报告)[J].肿瘤预防与治疗,2010,23:53-55.
[13]隋燕霞,党诚学,张勇,等.原发性胰腺神经内分泌肿瘤60例临床病理分析[J].临床与实验病理学杂志,2015,31:873-876.
[14]Pathak S,Dash I,Taylor MR,et al.The surgical management of neuroendocrine tumour hepatic metastases[J].Eur J Surg Oncol,2013,39:224-228.
[15]Kennedy A,Bester L,Salem R,et al.Role of hepatic intraarterial therapies in metastatic neuroendocrine tumours(NET):guidelines from the NET-Liver-Metastases Consensus Conference[J].HPB(Oxford),2015,17:29-37.
[16]Hur S,Chung JW,Kim HC,et al.Survival outcomes and prognostic factors of transcatheter arterial chemoembolization for hepatic neuroendocrine metastases[J].J Vasc Interv Radiol,2013,24:947-956.
[17]李晓光,金征宇,潘杰,等.肝动脉化疗或栓塞治疗胰腺神经内分泌肿瘤肝转移的疗效分析[J].介入放射学杂志,2010,19:442-446.
[18]房星宇,于淼,杨倚天,等.肝动脉化疗栓塞及射频消融治疗胰腺神经内分泌肿瘤肝转移的疗效和生存分析[J].介入放射学杂志,2013,22:377-380.