Transarterial Chemoembolization with Epirubicin-eluting Beads versus Transarterial Embolization before Liver Transplantation for Hepatocellular Carcinoma
Transarterial Chemoembolization with Epirubicin-eluting Beads versus Transarterial Embolization before Liver Transplantation for Hepatocellular Carcinoma
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DOI：
10.1016/j.jvir.2009.10.038
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发表时间：
2010-03-01
影响因子：
2.9
通讯作者：
Sangiovanni, Angelo
中科院分区：
文献类型：
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作者：
Nicolini, Antonio;Martinetti, Laura;Sangiovanni, Angelo
目的：回顾性比较移植等待名单上的患者采用负载表阿霉素的 DC Bead 化疗栓塞与温和栓塞后移植肝脏的放射学肿瘤反应和坏死程度。 材料和方法：从 2003 年到 2007 年，49 名肝细胞癌 (HCC) 患者在单一中心接受了移植。 16 名患者每隔一个月接受 100-300-μm Embosphere 颗粒的温和栓塞治疗（n = 8）或用负载表阿霉素的 100-300-μm DC Bead 颗粒进行化疗栓塞（n = 8），直至肿瘤完全断流。每 3 个月进行一次计算机断层扫描，直至复发。对移植的肝脏进行分析以评估结节的坏死程度。原位肝移植（OLT）后，对患者的生存率和疾病状态进行随访。结果：各组的基线特征具有可比性。大多数患者患有 Child-Pugh A 级疾病。 75% 的患者发现孤立性 HCC。平均目标病变尺寸为 32 mm +/- 15.4。药物洗脱珠化疗栓塞使 77% 的病灶完全坏死，而温和栓塞则使 27.2% 的病灶完全坏死。在组织学坏死方面，温和栓塞与 DC Bead 化疗栓塞之间存在显着差异 (P = .043)。两组均未观察到明显的治疗相关并发症。 15 名患者存活，未出现肿瘤复发。 结论：OLT 前使用药物洗脱珠进行化疗栓塞比单纯栓塞获得了更高的完全组织学缓解率，且未观察到严重不良事件。由于回顾性数据分析和小样本量，有必要进行进一步的研究来证实这些有希望的结果。
PURPOSE: To retrospectively compare radiologic tumor response and degree of necrosis in explanted livers after chemoembolization with epirubicin-loaded DC Bead versus bland embolization in patients on a transplant waiting list.MATERIALS AND METHODS: From 2003 to 2007, 49 patients with hepatocellular carcinoma (HCC) underwent transplantation at a single center. Sixteen patients were treated with bland embolization (n = 8) with 100-300-mu m Embosphere particles or chemoembolization with epirubicin-loaded 100-300-mu m DC Bead particles (n = 8) every other month until complete tumor devascularization. Computed tomography was performed every 3 months until recurrence. Explanted livers were analyzed to evaluate the degree of necrosis in the nodules. After orthotopic liver transplantation (OLT), patients were followed up for survival and disease status.RESULTS: The groups were comparable for baseline characteristics. Most patients had Child-Pugh class A disease. Solitary HCC was found in 75% of patients. Mean target lesion size was 32 mm +/- 15.4. Chemoembolization with drug-eluting beads achieved complete necrosis in 77% of lesions whereas bland embolization achieved complete necrosis in 27.2% of lesions. There was a significant difference between bland embolization and chemoembolization with DC Bead with regard to histologic necrosis (P = .043). No significant treatment-related complications were observed for either group. Fifteen patients are alive with no tumor recurrence.CONCLUSIONS: Chemoembolization with drug-eluting beads before OLT achieved higher rates of complete histologic response than bland embolization, with no serious adverse events observed. Because of the retrospective data analyses and small sample size, further studies are warranted to confirm these promising results.