Transarterial chemoembolization of unresectable systemic chemotherapy-refractory liver metastases from colorectal cancer: Long-term results over a 10-year period
Transarterial chemoembolization of unresectable systemic chemotherapy-refractory liver metastases from colorectal cancer: Long-term results over a 10-year period
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DOI：
10.1002/ijc.28443
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发表时间：
2014-03-01
影响因子：
6.4
通讯作者：
Vogl, Thomas J.
中科院分区：
文献类型：
--
作者：
Gruber-Rouh, Tatjana;Naguib, Nagy N. N.;Vogl, Thomas J.
本研究的目的是评价经动脉化疗栓塞术(TACE)治疗结直肠癌肝转移患者的疗效，并确定影响治疗成功的预后因素。共有564例结直肠癌肝转移患者(平均年龄60.3岁)反复接受TACE治疗。总共进行了3384次TACE手术(平均每名患者6次)。局部化疗方案包括单用丝裂霉素C(43.1%)、丝裂霉素C联合吉西他滨(27.1%)、丝裂霉素C联合伊立替康(15.6%)或丝裂霉素C联合伊立替康+顺铂(15.6%)。用碘油和淀粉微球栓塞术。使用磁共振成像或计算机断层扫描来评估肿瘤反应。计算肿瘤大小的变化，并根据RECIST标准评估疗效。生存率按Kaplan-Meier法计算。影响患者生存的预后因素采用LOG-RANK检验。局部肿瘤控制评价：部分缓解16.7%，稳定48.2%，进展16.7%。化疗栓塞术后1年生存率为62%，2年生存率为28%，3年生存率为7%。化疗栓塞治疗开始后的中位生存期为14.3个月。适应症(p=0.001)和初始肿瘤反应(p=0.015)是影响患者生存的统计学显著因素。对于结直肠癌肝转移患者，TACE是一种控制局部转移和延长生存时间的微创治疗选择。TACE化疗方案的选择、TN分期、肝外转移、病灶个数、肿瘤位于肝内的部位对患者的生存无显著影响。
The aims of the study were to evaluate therapeutic efficacy and to determine the prognostic factors for treatment success in patients with liver metastases from colorectal cancer (CRC) treated with transarterial chemoembolization (TACE). A total of 564 patients (mean age, 60.3 years) with liver metastases of CRC were repeatedly treated with TACE. In total, 3,384 TACE procedures were performed (mean, six sessions per patient). The local chemotherapy protocol consisted of mitomycin C alone (43.1%), mitomycin C with gemcitabine (27.1%), mitomycin C with irinotecan (15.6%) or mitomycin C with irinotecan and cisplatin (15.6%). Embolization was performed with lipiodol and starch microspheres. Tumor response was evaluated using magnetic resonance imaging or computed tomography. The change in tumor size was calculated and the response was evaluated according to the RECIST-Criteria. Survival rates were calculated according to the Kaplan-Meier method. Prognostic factors for patient's survival were evaluated using log-rank test. Evaluation of local tumor control showed partial response in 16.7%, stable disease in 48.2% and progressive disease in 16.7%. The 1-year survival rate after chemoembolization was 62%, the 2-year survival rate was 28% and the 3-year survival rate was 7%. Median survival from the start of chemoembolization treatment was 14.3 months. The indication (p = 0.001) and initial tumor response (p = 0.015) were statistically significant factors for patient's survival. TACE is a minimally invasive therapy option for controlling local metastases and improving survival time in patients with hepatic metastases from CRC. TN stage, extrahepatic metastases, number of lesions, tumor location within the liver and choice of chemotherapy protocol of TACE are none significant factors for patient's survival.