摘要
目的探讨钇‑90树脂微球经动脉放射栓塞(TARE)治疗初始不可切除肝脏恶性肿瘤的安全性和短期疗效。方法采用回顾性描述性研究方法。收集2022年6月至2023年6月陆军军医大学第一附属医院收治的10例初始不可切除肝脏恶性肿瘤患者的临床病理资料;均为男性,年龄为(57±4)岁。正态分布的计量资料以x±s表示,组内治疗前后比较采用配对t检验。偏态分布的计量资料以M(Q1,Q3)或M(范围)表示,组内治疗前后比较采用配对秩和检验。计数资料以绝对数或占比表示。结果(1)治疗前评估情况。10例患者均完成治疗前评估,其中8例行1次锝99‑聚合蛋白(99mTc‑MAA)灌注试验、2例行≥2次99mTc‑MAA灌注试验;10例患者99mTc‑MAA的肿瘤组织摄取值/周围正常组织摄取值、肝肺分流率、钇‑90树脂微球治疗需要量分别为5.8±1.2、4.8%±0.8%、(1.10±0.20)GBq。(2)钇‑90树脂微球TARE治疗策略。10例患者中,采用全肿瘤放射栓塞、主要靶病灶放射栓塞+非靶病灶射频消融术治疗、主要靶病灶放射栓塞+非靶病灶碘‑125粒子植入、肝叶或肝段放射栓塞分别为6、2、1、1例。治疗期间,1例高龄患者因不能耐受,未行靶向及免疫治疗,其余9例均联合靶向及免疫治疗。10例患者中,行1次和2次钇‑90树脂微球TARE治疗分别为7例和3例。(3)随访情况。10例患者均获得随访,随访时间为4.5(3.0~12.0)个月。随访期间,无患者发生与钇‑90树脂微球TARE治疗相关的不良反应。10例患者经钇‑90树脂微球TARE治疗前肿瘤长径、甲胎蛋白(AFP)、异常凝血酶原、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、白蛋白(Alb)、总胆红素(TBil)、谷氨酰转移酶(GGT)分别为96(72,135)mm、26(6,833)μg/L、290(56,2997)Au/L、(36±13)IU/L、(41+16)IU/L、(40±4)g/L、(15.3±4.1)μmol/L、(99±68)IU/L;治疗后90 d上述指标分别为63(43,97)mm、4(3,357)μg/L、38(25,142)Au/L、(40±16)IU/L、(51±28)IU/L、(39±4)g/L、(14.4±1.2)μmol/L、(134±93)IU/L;治疗前与治疗后90 d肿瘤长径、异常凝血酶原比较,差异均有统计学意义(Z=-2.08,-2.24,P<0.05),AFP、ALT、AST、Alb、TBil、GGT比较,差异均无统计学意义(Z=-1.27,t=0.63、1.69、1.73、0.67、1.30,P>0.05)。10例患者随访期间达到临床完全缓解5例、临床部分缓解4例,1例患者于钇‑90树脂微球TARE治疗后30 d内发生非靶病灶进展,患者疾病缓解率、疾病控制率均为9/10,随访期间无患者死亡。结论钇‑90树脂微球TARE治疗初始不可切除肝脏恶性肿瘤安全、可行,联合其他治疗方法可获得较为满意的短期疗效。
Objective To investigate the safety and short‐term efficacy of yttrium‐90[90Y]resin microspheres transarterial radioembolization(TARE)for the treatment of initial unresectable malignant hepatic tumor.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 10 patients with initial unresectable malignant hepatic tumor who were admitted to The First Affiliated Hospital of Army Medical University from June 2022 to June 2023 were collected.All patients were males,aged(57±4)years.Measurement data with normal distribution were represented as Mean±SD,and comparison before and after treatment within the group was conducted using the paired t test.Measurement data with skewed distribution were represented as M(Q1,Q3)or M(range),and comparison before and after treatment within the group was conducted using the paired rank sum test.Count data were described as absolute numbers or proportions.Results(1)Pre‐treatment assessment.All 10 patients completed pre‐treatment assessment,with 8 cases undergoing once of technetium 99‐polymerised protein perfusion test and 2 cases undergoing≥twice of technetium 99‐polymerised protein perfusion test.The ratio of uptake of technetium 99‐polymerised protein in tumor tissue to normal tissue,the hepatopulmonary shunting ratio and the therapeutic requirement of 90Y resin microspheres in 10 patients were 5.8±1.2,4.8%±0.8%and(1.10±0.20)GBq,respectively.(2)Treatment strategy of 90Y resin microspheres TARE.Of the 10 patients,cases treated with whole tumor radioembolisation,radioembolisation of the main target lesion+non‐target lesion radiofrequency ablation,radioembolisation of the main target lesion+nontarget lesion iodine‐125 particles implantation,radioembolisation of the liver lobe or liver segment were 6,2,1,1,respectively.During the treatment period,one elderly case did not receive target therapy combined with immunotherapy due to intolerance,and the remaining 9 cases received target therapy combined with immunotherapy.Of the 10 patients,there were 7 cases receiving once of 90Y resin microspheres TARE,and 3 cases receiving twice of 90Y resin microspheres TARE.(3)Follow‐up.All 10 patients were followed up for 4.5(range,3.0−12.0)months.During the follow‐up,none of patient had adverse event associated with 90Y resin microspheres TARE.The tumor diameter,alpha‐fetoprotein(AFP),abnormal prothrombin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(Alb),total bilirubin(TBiL),glutamyltransferase(GGT)of the 10 patients were 96(72,135)mm,26(6,833)μg/L,290(56,2997)Au/L,(36±13)IU/L,(41+16)IU/L,(40±4)g/L,(15.3±4.1)μmol/L,(99±68)IU/L before receiving 90Y microspheres TARE.The above indicators of the 10 patients were 63(43,97)mm,4(3,357)μg/L,38(25,142)Au/L,(40±16)IU/L,(51±28)IU/L,(39±4)g/L,(14.4±1.2)μmol/L,(134±93)IU/L after 90 days of receiving 90Y microspheres TARE.There were significant differences in tumor diameter and abnormal prothrombin(Z=−2.08,−2.24,P<0.05)and there was no significant difference in AFP,ALT,AST,Alb,TBil,GGT(Z=−1.27,t=0.63,1.69,1.73,0.67,1.30,P>0.05).During the follow‐up period,5 cases achieved clinical complete response,4 cases achieved clinical partial remission,and 1 case experienced non‐target lesion progression within 30 days after receiving 90Y resin microspheres TARE.The disease remission rate and disease control rate of the 10 patients were 9/10 and 9/10,respectively.None of patient died during follow‐up period.Conclusion 90Y resin microspheres TARE for the treatment of initial unresectable malignant hepatic tumor is safe and feasible,and can achieve satisfactory short‐term efficacy when combined with other treatment methods.
作者
邵明华
谭斌彬
付颖
陈志宇
弓毅
戴海粟
陈海蕾
张辉
Shao Minghua;Tan Binbin;Fu Ying;Chen Zhiyu;Gong Yi;Dai Haisu;Chen Hailei;Zhang Hui(Department of Hepatobiliary Surgery,The First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Department of Hepatobiliary Surgery,Jiangbei District of The First Affiliated Hospital of Army Medical University,Chongqing 400020,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2024年第7期969-975,共7页
Chinese Journal of Digestive Surgery
基金
重庆市自然科学基金(2023NSCQ‑MSX3527)。
关键词
肝肿瘤
初始不可切除
放疗
栓塞
治疗性
钇‑90树脂微球
疗效
Liver neoplasms
Initial unresectable
Radiotherapy
Embolization,therapeutic
Yttrium‐90 resin microspheres
Efficacy
