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首页|期刊导航|中国普通外科杂志|临界可切除肝癌行肝动脉灌注化疗联合肝动脉栓塞术转化治疗的疗效

临界可切除肝癌行肝动脉灌注化疗联合肝动脉栓塞术转化治疗的疗效OA北大核心CSTPCD

Efficacy of conversion therapy with hepatic arterial infusion chemotherapy combined with transarterial embolization for borderline resectable liver cancer

中文摘要英文摘要

背景与目的:对于临界可切除的原发性肝癌,目前我国原发性肝癌诊疗指南(2022年版)推荐仍是肝动脉插管化疗栓塞术(TACE)、外科手术切除或系统抗肿瘤治疗.当前原发性肝癌的术前转化治疗已经取得了很大的进展,但对于具体转化治疗方案尚在探索中.本研究探讨临界可切除肝癌行FOLFOX方案的肝动脉灌注化疗(HAIC)联合肝动脉栓塞术(TAE)局部转化治疗的真实世界疗效. 方法:收集2019年4月—2022年2月采用FOLFOX方案的HAIC联合TAE转化治疗的22例临界可切除(CNLC分期Ⅱb期)原发性肝癌患者的临床资料,根据改良实体瘤疗效评价(mRECIST)标准评估肿瘤客观缓解率(ORR)、疾病控制率(DCR),分析转化手术切除率和术后标本的病理缓解率以及转化治疗后手术与未手术患者的预后情况. 结果:22例患者均完成HAIC联合TAE治疗,主要不良反应包括上腹痛、低热、短期的肝功能损害等,但没有发生不可逆的严重并发症.转化治疗后,肿瘤ORR、DCR分别为63.6%、86.3%,但有3例(13.6%)患者出现肿瘤进展.转化治疗结束后14例患者行肝癌手术切除,转化手术切除率为63.6%,手术顺利,均能达到R.切除,无术后死亡病例.术后病理检查有10例(71.4%)为主要病理缓解(MPR),但无1例能达到完全病理缓解(CPR).14例手术患者的无复发生存期平均为14.7个月;手术患者的总生存期明显优于未手术患者(22.7个月vs.13.2个月,P=0.018). 结论:HAIC联合TAE转化治疗对于临界可切除肝癌具有良好的耐受性,是安全可行的,能取得较高ORR、DCR和转化手术切除率.虽然大多数术前转化治疗后能达到MPR,但CPR较低,手术切除仍是肝癌转化治疗后患者获得长期生存的关键.

Background and Aims:For borderline resectable primary liver cancer,the recommended treatment options currently in China according to the Diagnosis and Treatment Guidelines for Primary Liver Cancer(2022 edition)are still transcatheter arterial chemoembolization(TACE),surgical resection,or systemic anti-tumor therapy.Preoperative conversion therapy for primary liver cancer has made significant progress,but specific conversion therapy strategies are still under exploration.This study was performed to explore the real-world efficacy of local conversion therapy using FOLFOX regimen-based hepatic arterial infusion chemotherapy(HAIC)plus transarterial embolization(TAE)in the treatment of borderline resectable liver cancer. Methods:The clinical data of 22 patients with borderline resectable(CNLC stage Ⅱb)primary liver cancer who underwent conversion therapy using FOLFOX regimen-based HAIC combined with TAE from April 2019 to February 2022 were collected.Tumor objective response rate(ORR)and disease control rate(DCR)were assessed based on the modified response evaluation criteria in solid tumors(mRECIST).The conversion surgery rate,pathological response rate in postoperative specimens,and the prognosis of patients undergoing or not undergoing surgery after conversion therapy were analyzed. Results:All 22 patients completed HAIC combined with TAE treatment.Main adverse reactions included upper abdominal pain,low-grade fever,and short-term liver dysfunction,but no irreversible severe complications occurred.After conversion therapy,the tumor ORR and DCR were 63.6%and 86.3%,respectively,and 3 patients(13.6%)experienced tumor progression.Following the completion of conversion therapy,14 patients underwent liver cancer resection,and the conversion surgery rate was 63.6%.All surgeries were successfully performed and all achieved R0 resection.There were no postoperative deaths.Postoperative pathology showed major pathological response(MPR)in 10 cases(71.4%),but none achieved complete pathological response(CPR).The average disease-free survival for surgical patients was 14.7 months,and their overall survival was significantly better than non-surgical patients(22.7 months vs.13.2 months,P=0.018). Conclusion:HAIC plus TAE conversion therapy for borderline resectable liver cancer demonstrates excellent tolerability,proving to be a safe and feasible approach that achieves higher ORR,DCR,and conversion surgery rate.Although most patients achieve MPR after preoperative conversion therapy,CPR remains low.So,surgical resection still the key approach for patients to attain long-term survival after liver cancer conversion therapy.

郑本波;刘航;黄文;聂佳

四川省德阳市人民医院普通外科,四川 德阳 638000四川省德阳市人民医院血管介入科,四川 德阳 638000四川省德阳市人民医院病理科,四川 德阳 638000

临床医学

肝肿瘤化学疗法,肿瘤,局部灌注栓塞,治疗性预后

Liver NeoplasmsChemotherapy,Cancer,Regional PerfusionEmbolization,TherapeuticPrognosis

《中国普通外科杂志》 2024 (001)

36-43 / 8

10.7659/j.issn.1005-6947.2024.01.005

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