经皮微波消融同步肝动脉化疗栓塞治疗胃肠胰神经内分泌肿瘤肝转移的临床疗效

摘要

Objective To investigate the safety,effectiveness and prognosis of percutaneous microwave ablation (MWA) combined with synchronous transarterial chemoembolization (TACE) to treat of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) with liver metastases (LMs).Methods This retrospective study included 19 cases of GEP-NENs with LMs patients who received percutaneous MWA combined with synchronous TACE treatment from 2013 to 2016.The mRECIST standard was selected to assess the curative effect.SPSS 21.0 software was applied in the statistical analysis of overall survival (OS),progression-free survival (PFS) and factors related to prognosis.Results All patients were capable of curative effect evaluation,including 1 case of complete remission (CR),3 cases of partial remission (PR),7 cases of progressive disease (PD) and 8 cases of stable disease (SD) respectively accounting for 5 ％,16 ％,37 ％,42 ％,which exhibited 21％ of response rate (RR) and 63％ disease control rate (DCR).In the present study,the median OS and median PFS was respectively 25 months and 34 months,and the one-year survival and three-year survival was respectively 95％ and 84％.Serum CA199,the WHO classification of LMs and the tumor burden of LMs were the major risk factors of prognosis through single factor analysis of survival,which showed that G3 of the WHO classification of LMs predicted a poor OS (P＜0.05) and tumor burden of LMs was negatively related to PFS (P＜0.05).It was obviously observed that serum CgA was decreased by the therapy of percutaneous MWA with synchronous TACEfor GEP-NENs (P＜0.05).Conclusions Percutaneous MWA combined with synchronous TACE is a safe and effective method to treat GEP-NENs with LMs.%目的 研究经皮微波消融(microwave ablation,MWA)同步肝动脉化疗栓塞(transar terial chemoembolization,TACE)治疗胃肠胰神经内分泌肿瘤(gastroenteropancreatic neuroendocrine neoplasms,GEPNENs)肝转移的安全有效性以及预后影响因素.方法 回顾性分析2013～2016年接受经皮MWA同步TACE治疗的19例GEP-NENs伴肝转移患者.根据mRECIST标准评估客观疗效,利用SPSS 21.0软件统计分析患者总生存期(overall survival,OS)、无进展生存期(progression free survival,PFS)及相关预后影响因素.结果 所有患者均可评价疗效:完全缓解(complete remission,CR)1例(5％),局部缓解(partial remission,PR)3例(16％),疾病进展(progressive disease,PD)7例(37％),疾病稳定(stable disease,SD)8例(42％),有效率(response rate,RR)为21％,疾病控制率(disease control rate,DCR)为63％.全组患者的中位PFS和中位OS分别为25和34个月,1年、3年生存率分别为95％、84％.单因素生存分析发现,血清CA199,肝转移灶病理WHO分级以及肝转移灶肿瘤负荷是患者生存预后的主要风险因素,其中肝转移灶WHO分级达到G3往往提示患者中位OS较差(P＜0.05),而肝转移灶肿瘤负荷与中位PFS呈负相关性(P＜0.05).此外,经皮MWA同步TACE治疗GEP-NETs后,CgA水平较术前明显降低,且大部分降至正常水平(P＜0.05).结论 经皮MWA同步TACE是治疗GEP-NENs肝转移的安全有效方法.